Accxx/RSLCOM Agent Program On-line Signup

There are two agreements, the Full Service Agent Agreement and the Referral Agent Agreement.

Before submitting the On-Line Signup Form below, you are required to read the Agent Agreement that you have checked off.

Review Referral Agent Agreement

Review Full Service Agent Agreement

Review Accxx Commissions Appendix A ................. Review RSLCOM Commissions Appendix A



On-Line Signup Form

I have read the appropriate Agent Agreement checked below and agree to the conditions of this agreement.

Referral Agent Agreement         . Full Agent Agreement (valid only for paper form submission -- no web site submissions)

                  Name:
        Organization: (optional)
 Street address #1:
 Street address #2: (if needed)
       City/State/Zip:
     E-Mail address:
     
Commission checks will be made out payable to the Agent name indicated above and sent to the indicated address unless a different name and/or address is specified in the "Questions you would like to ask?" box below.

Questions you would like to ask?

 Back to the Phone Page

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