INDEPENDENT REPRESENTATIVE AGREEMENT
Section I: Acceptance of the Agreement
Welcome to the Asirvia business. Please read the Asirvia Independent Representative Agreement and Policies and Procedures carefully, collectively referred to as “IR Agreement.”
Section II: 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 Asirvia before an Asirvia Independent Representative Agreement can be executed.
Please read the following information carefully:
Section III: 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, you acknowledge by agreeing with the following, 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, you certify that:
You consent to the use of electronic records and have read, understand and agree to the Asirvia Independent Representative Agreement and Policies and Procedures.