713-493-2722 or 1-888-GRACE-89

Member Login

Become a Distributor and Start Your Own Home Based Business Today!
Independent Representative
Online Application and Agreement
Applicant Information
Enroller Information
Are You Working with a Grace Independent Repesentative?
Placement Information
Check if Permanent Placement is same as Enroller
Yes No
Include all felonies and misdemeanors other than traffic tickets.
Yes No
If YES, then please provide all relevant details below:
Representative Starter Kit
I elect to join as an Independent Marketing Rep **$150.00
I elect to join as an Independent Business Owner **$150.00
I elect to Purchase IMR Business Package and authorize monthly charged **$39.95
I elect to Upgrade my IMR status to IBO status **$150.00
Visa Master Card American Express Discover Card
I authorize GRACE PREPAID LEGAL GROUP, INC. to charge the credit card indicated below for the amount I have selected. If GRACE PREPAID LEGAL GROUP, INC. Business Package are purchased, I hereby authorize GRACE to charge my credit card $39.95 (respectively) per month. I understand I must give 30-day prior written notice in order to cancel such services.
 / 
Assumed Names, Corporations, Partnerships or Trusts. If your distributorship will be owned by a corporation, partnership or trust, or will be operated under an assumed name (e.g., XYZ Enterprises or John Doe and Associates), you must complete a Business agreement form and submit it with the Grace Prepaid Legal Group, Inc. Independent Representative Application and Agreement and Proof of Tax ID.

By checking the box below, I apply to become a GRACE Representative. I certify that I am of legal age (the age of majority) for the state in which I reside. I have carefully read the terms and conditions and agree to abide by them. I understand that, pursuant to the terms and conditions hereof, I am agreeing to arbitrate all disputes I may have against GRACE and any GRACE employees, agents, directors, officers, or affiliates in Houston, TX. I understand that I have the right to terminate my distributorship at any time, with or without reason. I agree that such termination must be in writing.

I accept the terms and conditions above.
Submit
Submit
Please review the form and correct the highlighted fields as follows:
Cannot be empty
Revalidation required
Also, please select the Starter Kit you wish to purchase.

Promotion qualifications are not valid and no commission or bonus checks will be sent to the applicant until GRACE receives the signed Application and Agreement. Your canceled check or credit card charge, and your first monthly bonus report constitute your receipt and verification that your Application and Agreement has been accepted by GRACE. If a check is refused for insufficient funds, then you will be charged a $25 fee.

*By entering my Social Security (or Federal Tax Identification Number, if applicable) on this Representative Application and Agreement, I certify that this number is my correct taxpayer identification number. I have not been a GRACE Representative, or a partner, shareholder, or principal of any entity having a GRACE distributorship within the past one year. I understand that any intentional misrepresentation of any information I provide on this Application and Agreement may result in action by GRACE, up to and including termination of this Application and Agreement.
Name*:
E-mail*:
Phone*:

  


March 10th, 2010