Referrals | IT Services | DBA IT LLC

Referring Party Information

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First name

Last name

Email

Phone number

I'm looking to refer services:

Type more info as need or if other add more info or type N/A

Client Information

Client Information

First Name

Last Name

Email

Phone Number:

Street Address

Street Address 2

City:

State / Province:

Postal / Zip Code

How Soon do they need help?

Preferred Contact Method:

Effective Date of Agreement

Effective Date of Agreement

WHEREAS, the Referring Party refers the Client to the Receiving Party with the intention of receiving compensation if the client completes services. Payouts will be given after completion of services

Compensation Agreement

Compensation Agreement

Any and all payment will be net of what DbaIt llc receives and any Payment will only be given based on the following 2 choices on the next question do you agree?

Do You Want The Following Payment? Choose one

Expiration Agreement

Expiration Agreement

If client cancels services then payout will stop the following month. Please make sure to have a PayPal e-mail make sure to include email for payments so I can send payouts Select I agree below

What is your PayPal Email for payouts

Referring Associate's Conformity

Referring Associate's Conformity

Free Text

I hereby confirm that all information given above are true and correct. I understand that any false information herein may be grounds for the cancellation of this agreement and its assigned to disapprove the release of my application as a Referring Associate.

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First Name:

Last Name:

Date: