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Unik Media Group - Payment Enrollment Form

Please fill out the required information below to be added to our payment network.

Contact Information

Account Type*

First name*

Last name*

Company name

Email/Accounting*

Phone number*

Street address*

House number, Street, Unit/Apt/Suite #

City*

State/Region*

Postal code

Country/Region*

Bank Information

Bank Name*

Routing # (ACH)

Routing # (WIRE)

Account #*

Mobile phone number

EIN # / Foreign TIN #*

Vendors who uses Form W9 must enter valid and current EIN / Vendors who uses Form W-8BEN you must enter a valid foreign TIN

Upload your W9/W8*

Please make sure the form is current and up to date. UNIK Media Group will NOT be responsible for any missing/incorrect information submitted by Vendor.