| Name: _______________________ | ID:_______________________ |
| Pay Level:_______________________ (Team Captain or Higher) | |
| Currency Region:_______________________ (examples: Europe, or UK, or NZ) | Currency Type:_______________________ |
I understand that I am required to provide a signed receipt to each person that I am transmitting funds for and that I will transmit all payments within 72 hours of receipt of the funds, to ClubShop Rewards. I agree that I will not profit from or retain any fee for acting as a Transmission Agent. I also understand that if I fail to honor all the provisions of the Abuse and Fraud Policy or the provisions included in this application, that I can have my Fees Transmission Agent title and privilege removed and that I can have the fees that I have received, but not transmitted to ClubShop Rewards, deducted from my commissions or Club Account on behalf of the Partner's that I have received fees from. I also understand that my failure to transmit fees or to abide by the Abuse and Fraud Policy, may result in the termination of my membership.
| Signature | Date |
| Mail to: ClubShop Rewards, 2828 S. McCall Road, Suite 13, Englewood, FL 34224 | Fax to: 941-475-4081 |