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*
- denotes a required field
**
- denotes a required field only for US Partners
Agent
Signup
First Name
*
Last Name
*
Business Legal Name
(Full Personal Name if Sole Proprietorship)
*
This must exactly match the registered business name with the IRS for US entities. If there is not enouph space it is ok to truncate but do not abreviate. It can be the same as the Doing Business As (DBA) name or different. It is the individual's Legal Name for Sole proprietorships. When filling out this field, please do not enter "Same" or "N/A" for Company (Legal Name).
S
Business DBA (Doing Business As)
*
This is the name of your company as it appears on the customer's billing statement. It may be different than your Company (Legal) Name. When filling out this field, please do not enter "Same" or "N/A" for Business DBA.
Make Check Payable To
Legal Name
or
DBA Name
*
Legal Status
Corporation
Government
Sole Proprietorship
Legal/Medical Corp.
Int'l Org.
LLC
Non-Profit
Other
Partnership
Sole Proprietorship
Tax Exempt
Trust/State/Ass.
Federal Tax ID or
Social Security Number
**
ex. 111334444
Email
*
Business Address (Must be a physical address, not a PO box)
Address
*
The address used when registering the business. May be the home address.
City
*
State
*
Region
(If outside U.S.)
Zip
*
Country
*
Mailing Address (Checks will be mailed to this address)
Same as Business Address
Address
*
City
*
State
*
Region
(If country not U.S.)
Zip
*
Country
*
Do you want to sign up for Direct Deposit? (Must be a US based Financial Institution)
Yes
No
Business Phone
*
Ex: 323-965-2840
Home Phone
Mobile Phone
Fax
Site URL
Comments
Notify me by Email when I make a Sale
Yes
No
User Name
*
Password
*
Six characters minimum
Confirm Password
*
Password Hint
*
W-9 Form
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Agreement
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Authorization Form
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