Coregistrations | Coregistration | Co-registration

PARTNER INFORMATION

Company

First Name

Last Name

Street Address

Apt. / Suite

City

State

Postal / Zip Code

Country

Phone

Fax

How did you hear about us?

SITE INFORMATION

Site Registrations/Day

Site Type

Site Description
(255 character max)

Website 1 (consumer)

Site Category 1 (consumer)

Website 2 (corporate)

Site Category 2 (corporate)

Website 3

Site Category 3

PAYMENT INFORMATION

Make Payment To

SS# / Corp Tax ID / EIN / TIN

Check the box if you have had a previous account with Trancos Inc.

Exempt from backup withholding

Type of organization

Please specify other:

Sign your W-8BEN form electronically

By typing your name, you agree that this will represent your signature for certifying your W-8BEN, and that the information you provided above is true and correct. To sign this Certification, please enter your first and last name.

We are now sending payment via wire. Our threshold is $1000.00 for wire payment. If you wish to receive your payment transferred directly into your account, please fill out the information below. We are encouraging our publishers to use this method because you will receive your payment several days sooner than a live check.*

Send my payments via wire
Send my payments via a live check

W-8BEN Instructions | Preview your W-8BEN Form

Comments

I agree to the the CoregMedia terms and conditions.