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Billing account set-up form
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* Indicates required question
Email
*
Your email
Advertiser Name
*
Your answer
Billing Company Type
*
Advertiser
Agency
Third Party
Freelancer
Other:
Billing Company Name
*
Your answer
Billing Contact Name
*
Your answer
Billing Company Street Address
*
Your answer
City
*
Your answer
State (if in U.S.)
Your answer
Province/County/Etc. (if outside U.S.)
Your answer
Zip Code/Postal Code
*
Your answer
Country
*
Your answer
Direct Phone Number
*
Your answer
Billing email address
*
Your answer
If there are additional people/departments that need to be sent invoices and/or statements, please provide the email addresses below.
Your answer
Email of billing account administrator(s)
*
Your answer
Email(s) of billing account user(s)
*
Your answer
Do you require any additional documentation from Ad-ID to set up payment?
*
W9
Vendor Form
N/A
Other:
Required
Name of person who filled out this form
*
Your answer
Email address of person who filled out this form
*
Your answer
Add your initials here to indicate you’ve read this form and you confirm that the information entered is correct.
*
Your answer
Date
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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