New Client Account - Media Quest

Company

This field is for validation purposes and should be left unchanged.

Billing Contact

Billing contact name(Required)

Billing email(Required)

Phone(Required)

Additional invoice email(s), if any

Billing Address

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Shipping Information

Shipping Address

Shipping address is the same as billing address

Shipping Address

If different, enter shipping address and any delivery instructions below.

Street Address Address Line 2 City State ZIP Code

Delivery instructions, if any

Client Representative

Main contact for projects, approvals, questions, and communication.

Client Representative

Same as billing contact

Client representative name

Email

Phone

Person authorized to approve project changes / additional charges (if different)

Accounts Payable / Invoice Requirements

If invoices or statements should go to someone else, enter name and email

Does your company require a PO number on invoices?(Required)

Yes

No

If yes, who provides the PO number?(Required)

Do you use an A/P portal or vendor system for invoices?(Required)

Yes

No

If yes, provide portal information or instructions(Required)

Other billing instructions or requirements

Sales Tax / Tax-Exempt Status

Is your organization exempt from sales tax?(Required)

Yes

No

Tax Exemption Certificate

Tax Exemption Certificate attached

Upload your Tax Exemption Certificate

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 2 MB.

If tax exempt, attach a current Tax Exemption Certificate. We cannot mark your account tax exempt without it.

Form of Payment

How do you plan to pay Media Quest invoices?(Required)

If you selected Other, please specify

Banking Information for ACH / Direct Deposit

Use the information below to set Media Quest up in your accounts payable system for ACH or direct deposit payments.

Bank: JPMorgan Chase Bank
Routing number: 111000614
Account number: 646989426

If your A/P system requires additional banking documentation, please contact accounting@mediaquestweb.com.

New Client Account Form

Company Information

Billing Contact

Billing Address

Shipping Information

Client Representative

Accounts Payable / Invoice Requirements

Sales Tax / Tax-Exempt Status

Form of Payment

Banking Information for ACH / Direct Deposit