Become a Sales Rep

* Membership Type

Associate Affiliate/Sales Rep Program Free UHA Sales Rep Application. This is an affiliate program. Commissions paid 40% on new sales and 10% residual for annual renewals.

* First & Last Name

* Business Name

Business Name, if not applicable write None

Website

Business Website

* Business License

Do you have a business license?
If N/A enter No

yes
no

* Year business opened

What year did you open your business?

* Insurance

Do you have current business insurance?
If N/A enter no

yes
no

* Tax id #

Tax id or social security # required for verification to become certified and fraud protection.also needed for affiliate program.

* Birthday

Date of birth

* convicted of felony

Have you been convicted of a felony?

yes
No

If Yes

If yes please explain

* W9 form required

Before you can receive any commissions you must email a signed copy of a w9 along with a copy of your DL and SS card to taxinfo@theuha.net

I understand and will do.

Address Information

* Street

Street (Second Line)

* City

* ZIP Code

* Country

* State

* Phone Number

* Your E-Mail Address

a confirmation email will be sent to you at this address

* Confirm Your E-Mail Address

* Choose a Password

must be 4 or more characters

* Confirm Your Password

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