International Pay Agent Application
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Name:________________________________ID Number:________________________________
Pay Level:________________________________
(Team Captain or Higher)
COUNTRY:__________________________
Currency Type:________________________________
Transfer Fee Percentage (The percentage of the fee you want to charge to offset your costs to send us funds)__________________________%
Select your methods of payments you are able to use to send funds to the DHS Club:
Credit/Debit Card:___________
PayPal:___________
Western Union:___________
Wire Transfer ($25.00 cost):___________ Wire Transfer Form

I have read and agree to the provisions of the International Pay Agent program. I understand that I am required to disburse all payments within 72 hours of receipt of the funds from ClubShop Rewards. I understand that if I fail to honor all the provisions of the Pay Agent program, that I can have my Pay Agent title and privilege removed and should I fail to pay the entitled members their complete entitlement within 15 days, that I can have their entitlements deducted from my commissions and paid on my behalf by ClubShop Rewards. I also understand that my failure to pay my assigned members per their entitlement may result in the termination of my membership.

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Signature
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Date