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Fill out the form below to receive ACH deposits for administrative fees.

Registration for Fee Payments

Legal Name *

Aliases (Any other names you may go by, especially in a business capacity)

Accurate information is needed. Typos or incorrect information could cause delays with your payment profile and payments.

Email *

Phone *

Address Line 1 *

Address Line 2 (City, State, Zip) *

Financial Information

Bank Name *

Name on Bank Account

Bank Routing Number *

Bank Account Number *

Business or Personal Account *

Checking or Savings Account *

Please Upload a Filled Out W9 Form. You can Find a blank one at: https://www.irs.gov/pub/irs-pdf/fw9.pdf

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages and phone calls from the business.

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