Onboarding Information Request

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ae_name

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Agency

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Submission ID

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Send questionnaire?

Company Name(Required)

Your Name(Required)

Do You Have Payment Information On Hand?(Required)

Yes

No

Billing Information

Please provide billing contact information related to your account.

Billing Point of Contact's Name(Required)

First Last

Billing Point of Contact's Email(Required)

Billing Point of Contact's Phone(Required)

Payment Method Selector

Choose how you'd like to be billed. ACH bank transfer is free. Credit and debit cards carry a 3% processing fee per charge. Your selection determines what we collect next, and either option is secure and encrypted.

Payment Method Selector(Required)

Credit Card

ACH/Bank Account

Credit Card

A 3% processing fee applies to all credit and debit card payments. This fee covers the cost charged by our payment processor and is added to each transaction. To avoid this fee, go back and select ACH / Bank Account, which has no processing surcharge. Enter your card details below. This information is encrypted end to end and accessible only to our finance team.

Card Holder Name(Required)

Card Number(Required)

Expiration Date(Required)

CVV(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

ACH / Bank Account

Enter your bank details below. ACH is the lowest-cost option for both of us and processes automatically each cycle. This information is encrypted end to end and accessible only to our finance team.

Bank Name(Required)

Account Type(Required)

Routing Number(Required)

Account Number(Required)

Authorization & Consent (Credit Card)

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Array Digital in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. I certify that I am an authorized user of this credit card account and will not dispute these scheduled transactions with my credit card company; so long as the transactions correspond to the terms indicated in this authorization form.

Signature(Required)

Authorization & Consent (ACH)

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Array Digital in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. In the case of an ACH transaction being rejected for non-sufficient funds (NSF) I understand that Rival Digital may at its discretion attempt to process the charge again within 30 days and agree to an additional $25.00 charge for each attempt returned by NSF. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this bank account and will not dispute these scheduled transactions with my bank; so long as the transactions correspond to the terms indicated in this authorization form.

Signature(Required)

Will you be the Billing Point of Contact going forward?

Yes

No

Billing Information

Please provide billing contact information related to your account.

Billing Point of Contact's Name(Required)

First Last

Billing Point of Contact's Email(Required)

Billing Point of Contact's Phone(Required)