Lead Partner Registration Form

Vendor Information
Legal Name
DBA Name
Address
City/State/Zip
Country
Vendor Contact Information
Sales Contact Name
Sales Contact Phone
Sales Contact Email
Accounts email for payment notification
Leads Contact Name
Leads Contact Phone
Leads Contact Email
Leads Vendor Email
Vendor Banking Information - Full wire information needed
Bank Name
Bank City
Country Code
Beneficiary Legal Name
SWIFT Code
Routing#/BSB Code
IBAN Number/CLABE #
RUT#
VAT#/TAX ID#
IRC#
Account Number
Currency of Invoicing

Signature:

[signature* signature-384 color:#000000 backcolor:#f3f3f3 height:120 class:lprf-sig]

All invoices must be submitted to [email protected].

Invoices will only be accepted for completed campaigns, confirmed by the Lead Delivery Team at Lynchpin Media Ltd. This includes campaigns which are subject to pacing caps.