* - denotes a required field
** - denotes a required field only for US Partners
Agent Signup
First Name * 
Last Name * 
Business Legal Name (Full Personal Name if Sole Proprietorship) * 
Business DBA (Doing Business As) * 
Make Check Payable To   or *
Legal Status
**ex. 111334444    
Email *   
Business Address (Must be a physical address, not a PO box)
Address *  
City * 
State *
Region (If outside U.S.)
Zip * 
Country * 
Mailing Address (Checks will be mailed to this address)
Address * 
City * 
State *
Region (If country not U.S.)
Zip * 
Country * 
Do you want to sign up for Direct Deposit? (Must be a US based Financial Institution)  
Business Phone *   Ex: 323-965-2840  
Home Phone
Mobile Phone
Fax  
Site URL
Comments
Notify me by Email when I make a Sale
User Name * 
Password *   Six characters minimum
Confirm Password *   
Password Hint *  
W-9 Form Download, complete and return this form.
Agreement Download, complete and return this form.
Authorization Form Download, complete and return this form.

Submit this form to signify that you have read, understood and agreed to the Terms & Conditions of our Agreement
Copyright © 2022 Commerce Technologies.