Contact Name:
Owner/Principal Name:
Corporation Name:
Business Name:
Business Address:
City:
State:
Zip Code:
Federal Tax ID # or S.S. #:
Business Phone Number:
Fax Number:
Email Address:
Web Address:
Referred By:

Applicant applies for an account with The EXchange and agrees to abide by all the current trading procedures and policies, which may be modified from time to time. Applicant agrees to pay the initial administrative charge of $295.00 cash and a 12% cash transaction fee on all purchases. A $50.00 cash administrative charge will be debited to each account upon the anniversary date. An administrative fee of $10tds will be automatically debited to each client’s account monthly. Clients must give 30 days written notice of intent to cancel membership. All fees, including the initial set up fee, are in payment for services rendered in processing clients into The EXchange system, maintaining records, and facilitating the client’s use of The EXchange. I agree to all terms and conditions, rules and procedures on the back of this application.