Amount Paid : $299.00

Independent Agent Agreement

Enrollment Information


First Name
Middle Initial (Optional)
Last Name
Select
Select
Address
APT / SUIT (Optional)
City
Select
Zip Code
Email
Verify Email
Cell Phone
DOB
SSN

Membership

Information

Password
Conf. Password

Payment Information

Enter your card information:
select
Card Number
Select
Select
CVV

Language

Agent Information

Agent ID :  571481

Agent Name :  Eboni Leblanc

Commission

By choosing this option, I authorize United Wealth Education to electronically deposit my commission in the specified account. I also understand that a $4.00 processing fee will be taken out of my weekly commission payment

By choosing this option, I understand that my commission and bonus checks will be on hold until such time that I can set up a Direct Deposit method*. At that time, I will set up payment through the Direct Deposit Form in my Agent Back Office portal.

*Agents can get direct deposit with a typical bank account or by using a online service like Cash App, Chime, Ally, or Axos.

*I understand that a $4.00 processing fee will be taken out of each weekly commission payment when I choose this option.

Direct Deposit Information
Bank Name
Acc. Holder Name

Account Type

Account #
Routing #

Term & Conditions

I consent to the use of electronic records and have read, understand and agree to the United Wealth Education Services/YFL IR Agreement Policies and Procedures: