Presented By: Robert Bellot

Electronic Signature Information

ELECTRONIC SIGNATURE INFORMATION

Independent Business Owner Agreement

Section I: Acceptance of the Agreement

Welcome to the Four Corners Alliance Group business. Please read the Four Corners Alliance Group Independent Business Owner Agreement and Policies and Procedures carefully, collectively referred to as “IBO Agreement.”

Section II: Monthly Billing

Administrative fees are collected each month with a credit or debit card maintained on file with Four Corners Alliance Group. The IBOs may make adjustments to their monthly subscription in the back office of the Four Corners Alliance Group website.

Section III: E-Sign Notice- Consent to Electronic Record

E-Sign, the Electronic Signatures in Global and National Commerce Act (15 U.S.D. 7001, et seq.), requires that you consent to entering into an electronic agreement with Four Corners Alliance Group before a Four Corners Alliance Group IBO Agreement can be executed.

Please read the following information carefully:

  • If you enter into an online Agreement with Four Corners Alliance Group, you will not be required to submit a paper application. An electronic record will evidence the entire agreement between you and Four Corners Alliance Group. However, you must consent to the use of an electronic record and must read the Four Corners Alliance Group Terms of Use, Four Corners Alliance Group Policies and Procedures and the Four Corners Alliance Group Compensation Plan, and electronically acknowledge below that you have read these documents.
  • To access these documents and submit your online IBO Application, you will need a personal computer or Mac with Internet access and operational Internet browser software.

By clicking on “I agree” below, you consent to the use of electronic records evidencing your agreement to the Four Corners Alliance Group Terms of Use, Policies and Procedures and the Compensation Plan of the Four Corners Alliance Group IBO Agreement. If you click on the “I Decline” box, the enrollment process will be terminated and you will be returned to the Four Corners Alliance Group Home page.

Section IV: IRS W9 Information

The Tax ID number must match the name as shown on your income tax return to avoid backup withholding. For individuals, this is your social security number.

Please verify the information submitted on your enrollment form. If correct, acknowledge by checking the box below, which will serve as your digital signature. For further information, please see the official IRS W9 form instructions: http://www.irs.gov/pub/irs-pdf/fw9.pdf

Under penalties of perjury, I certify that:

  • The information submitted is correct
  • You are not an exempt payee (generally, individuals, sole proprietors are not exempt from backup withholding)
  • The IRS has not notified you that you are currently subject to backup withholding
  • I am a U.S. citizen or U.S. resident alien (individual/sole proprietor)

I consent to the use of electronic records and have read, understand and agree to the Four Corners Alliance Group IBO Agreement and Policies and Procedures.

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