Agent Form

Fill up this form completely and click submit to process your Agent Application. A representative will be contacting you regarding the status of your application.

FILAM PHONE CLUB
AGENT SIGN-UP FORM
General Information

Name:
Address:
Tel. No.:
Email:
Date:

Agency Information

(Note: There are two type of agents: a sub-agent and a master agent. If you are being sponsored by another agent, you will start out as a sub-agent. If so, check the box below indicating this and provide the information requested about your sponsoring agent. If you are being sponsored by FilAm Phone Club or are a sub-agent who has signed up at least 12 new Fi1Am Phone Club members, you can sign up as a master agent. If so, check the box below indicating this.)

	I am applying as a sub-agent of FilAm Phone Club
If you are applying as a sub-agent, give your Master Agent’'s information:
Name:
Agent Number:
	I am applying as a master agent of FilAm Phone Club.

(Note: If you are already a sub-agent and are now applying as a master agent, both of your agent numbers will be used You sub-agent number will be used to track your direct commissions for all existing and new FilAm Phone Club members you personally sign-up. You master agent number will be used to track your override commissions for all sub-agents that you sign up.)

Office USE Only:

Agent No. Assigned:
Date:
Authorized Signature:

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