Partner Application

Name
Birth Date
Company Name
Position
Company Website
Facebook URL
linkedIn URL
Address
City
State
Zip
Business phone
Mobile phone
Email address
Favorite Charity
Emergency contact
Phone
How did you hear about us
Referred by

Are you interested in Moderating or participating on a committee?
Current Industry
Geographic preference for meetings
Describe your business and what you do
I agree to fully comply with the policies and procedures of Elite Success Partners II LLC. I am also aware that I and/or my family may be photographed and give my consent to use the photos to promote Elite Success Partners II, LLC..

AUTHORITY FOR PRE-AUTHORIZED PARTNER PAYMENT

Fees and Dues

Annual Partnership Fee – Upon acceptance into Elite Success Partners II LLC, partner agrees to a nonrefundable annual Corporate Partnership fee of $850.00

Monthly Partnership Dues are $60.00 per month. Dues are for the following month and will be collected electronically on a monthly basis unless paid in full at time of submitting application.

I authorize Elite Success Partners II LLC to charge the credit card indicated in this authorization form. If the above noted payments fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the business in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date. This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card and that I will not dispute the scheduled payments with my credit card company provided the transactions correspond to the terms indicated in this authorization form.

I have read and understand the above statement

Elite Success Partners II, LLC reserves the right to accept or deny any person for partnership and also terminate a partnership for any reason at their sole discretion.

Enter The Text You See Here Below captcha