Membership Application | The Sip Social

About Your Business:

What membership level would you like to be in?

Contact Name/Title *

Business Name *

Contact Email *

Contact Phone *

Website or Facebook Link

Tell us what services you will offer? *

Tax Information:

EIN/SSN

Tax Entity Type

Tax Entity Name

Mailing Address:

Street *

Suite

City *

State *

Zip Code *

Country *

Credit Card Information and Billing Address:

Cardholder Name *

16 Digit Card Number *

3-4 Digit Security Code *

Expiration Month *

Expiration Year *

Billing Address same as Mailing Address *

Phone *

Email *

By submitting this application to become a member of Sip Social, you affirm that you meet the membership requirements and agree to abide by these Terms & Conditions.

Accept the terms *

Sales rep that worked with you