Client Registration - New York City

Client Registration Form

To receive access to our Pricing, All clients must register and agree to our General Terms of Service. Register as a client and agree to our terms of service for Nathan Patrick Media
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Company/ Brokerage Name
Address (For Invoices)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What Regions do you practice Real Estate
Which statement best describes you and your registration:
Payment Responsibility Agreement/Certification

I understand that all projects will be billed to my company’s monthly invoice if a vendor relationship has been established. If no such agreement exists, or if my company does not honor payment, I agree to be personally responsible for all charges for services and products related to this project.Payment may be made by credit card (Square), Zelle, or Venmo.If I am responsible for payment and my company requires internal work orders for marketing requests, I agree to submit all required requests to ensure projects are paid in accordance with my company’s policies.
By clicking the Register & Agree button below, you agree to and accept the Terms of Services/Terms and Conditions: (Click Here for a direct link to the terms of Service/Terms and Conditions)
Should be Empty:

Client Registration Form