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ENVOY REPRESENTATIVE (AR) AGREEMENT

Please fill in the blanks with your information and select "Submit" at the bottom of the page.

E-mail Address: *
First Name: *
Last Name: *
Date of Birth: *
SSN: *
Spouse / Partner:
Home Phone: *
Work Phone:
Other Phone:
Fax Number:
Mailing Address: *
City: *
State: *
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Shipping Address
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Your Sponsor: *
Please Select a Training Package: *
Comments:
By CHECKING THE BOX BELOW I am applying to become an Account Representative (AR) of Envoy. I understand that, if accepted, my status will be that of an independent contractor and not that of an employee of Envoy. I acknowledge that I have been presented with a copy of Envoy’s Policies and Procedures, have read and understood them, and agree to abide by them as a material condition of becoming an Envoy AR. I further acknowledge that the optional training programs provided by Envoy have been presented to me. I understand that there is no cost to me to become an Envoy AR. My selection of an optional training program (if applicable) for which there is a cost is based entirely upon my desire to take advantage of the additional training and/or sales and marketing benefits provided by the program. *
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