Web Form submitted - Powered by Keap

Sales Agent Agreement

First Name *
Last Name *

Street Address *
City *
State *
Zip Code *

Cell Phone *

Home Phone *

Email *

* I Understand And Agree To All Of The Valued Merchant Services Independent Contractor Sales Agent Agreement, Compensation Plan, Promotions & Incentives

VMS SALES AGENT AGREEMENT - CLICK HERE

Agent Initials *

INDEPENDENT CONTRACTOR

Full Name *

Type Name Here As Signature *

Today's Date *

Social Security Number or Tax ID *

Date of Birth *

Drivers License, State ID or Passport Number *

I consent to a background check conducted by VMS or an authorized third party

Background Check Initials *

Direct Deposit Enrollment (Optional)

Bank Name

Routing Number

Bank Account Number

*If I do not enroll in direct deposit, I understand Valued Merchant Services will regular mail via USPS all commissions and residual payments due

* I understand and agree that by submitting my information above, I am officially joining Valued Merchant Services as an Independent Contractor / 1099. I also give Valued Merchant Services permission to contact me via email, phone and text messages (You can opt-out at anytime).

Agent Initials *

Please send copies of your photo ID, social security card or Tax ID documents to [email protected]

We will send an IRS W-9 form to complete & sign