Connection Exchange Licensee Order Form
Congrats on joining the community of The Connection Exchange! We're thrilled to have you! Please complete the below order form and we will send our Affiliate License Agreement and an invoice within 48 business hours to get you started! 
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Email *
Your Name (First and Last) *
Your Business Name (if the License agreement will be signed by an existing legally organized entity)
Your Address (Street, City, State, Zip) *
Your Phone Number (including area code) *
Your desired Connection Exchange location(s) (City, State and Zip) *
Your desired Connection Exchange service offering(s):
(You may offer both services with no additional fees other than ordering welcome gift bags)
 *
Connection Exchange Licensees pay an annual license fee of $599/location as well as a $249/mo/location ConnectS Software fee (at month 7 and ongoing).
Check below that you agree to these terms.
*
Start-Up Kit you wish to purchase: *
Quantity of Welcome Gift Bags you wish to purchase/service offering/location:
(Bag pricing dependent on current rates and quantities; we will advise you of pricing on your invoice; minimum order $1,250)
 *
A copy of your responses will be emailed to the address you provided.
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