Badger Barter - Membership Application

Membership Application

Name *
Email Address *
Legal Name of Business: *
Federal Taxpayer ID Number *
Company Type: *
Doing Business As: (DBA) *
Business Address 1: *
Business Address 2:
City: *
State: *
Zipcode: *
Business Phone: *
Business Fax
Your Job Title: *
Cell Phone:
Home Phone:
Email Address: *
Website Address:
Home Address 1:
Home Address 2:
City:
State:
Zipcode:
Goods/Services Available At 100% Trade: *
Trade Limits: *
Referred to Badger Barter by:
Additional Comments:
	1. Member agrees to abide by the existing rules and regulations of Badger Barter and understands that the Rules, Regulations and Procedures are part of this Membership Agreement. Check box to agree.
	2. Statements on member's trading activity reflecting all sales and purchases are computed monthly and will show dollar balance and service charges. Cash service charges are due and payable upon receipt. Check box to agree.
3. Select one of the plans below: *
	Plan A - Initiation Fees: $129. Cash, $5 cash & $5 trade, 6% on all transactions.
Auto-Pay Plan - Authorize cash fees to be automatically charged to my credit card after the 6th of each month.
	4. In the event if and breach agreement by Member, Member agrees to pay reasonable attorney fees, court costs, collection costs and interest. Check box to agree.
	5. This agreement cannot be assigned, transferred, or sold without prior written consent of Badger Barter and is binding upon heirs, successors, assigns, and administrators of Member. Check box to agree.
	6. Overdrafts may be available upon Badger Barter approval. This overdraft privilege, if used, will constitute a debt to the system. Check box to agree.
	7. Badger Barter shall bring Member new business during initial 12 month period, or return initiation fees. Check box to agree.
8. The names listed to the right are authorized users of the Member's trade account. *
	9. The above information is true and correct to the best of my knowledge. Check box to agree.

* Fields marked with an asterisk are required fields

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