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 		BIZ Global Media Inc. - ID: 5000  
 
Agency PDF Form
Agent PDF Form
 
STEP 1 - Enter your Ad Agency business center information.    
Agency ID:
* BIZ Agency who referred you
Your BIZ Ad Agency Name:
*Your choosen BIZ Agency Name
Tax ID#:
*  Social Security or Business Tax ID#
First Name:
*
Last Name:
*
Address:
*
Address 2:
City:
*
State:
 *
Zip:
*
County:
*
Phone:
*
Cell:
* country code, areas code and number
(no leading zero, no spaces, dots or dashes: example for USA 19492310567)
Email:
*

STEP 2 - Enter your payment information
You authorize BIZ or its authorized financial institution to withdraw the initial payment and monthly payment from this account for the entire term of this agreement.

Select your payment method and fill relevant payment section:  Pay by Bank Account   Pay by Credit Card

Please fill out your checking account information below:
Checking account Routing number  *
Checking account number  *
Check Number
Name of account holder  *
Name of Bank  *
Phone number of Bank:

Please fill out your Credit Card account information below:
Name Card Holder
Credit Card Number
Expiration Date
Card Identification Number (Three or four digit number on card -- see below) 
 

 
Termination/Cancellation of Service: You must provide written notice of cancellation within 29 days of your billing date or you will be charged for the next month of service. There are no refunds for unused message credits, and there are no prorated refunds under any circumstances. Also there is no refund available on the setup fee or monthly fee once the personal website and keywords are activated. Cancellations must be in writing and faxed or mailed to BIZ corporate office.

I have read and agree to BIZ Agency Policies and Conditions.   Click Here

  

I have read and agree to BIZ Agency Owner Terms and Conditions.   Click Here