Twenty & Oak Registration Form

William M. Bird Account #: *

Account Name:

WMB Sales Rep Name: *

SELECT MEMBERSHIP

By signing below, I am agreeing to pay $50 per month per location billed annually to be on the SELECT plan. I authorize Twenty & Oak to bill me via invoice through my store's William M Bird account. I may elect to have my information removed at any time from the Twenty & Oak site. Twenty & Oak is committed to promply remove this information at my request. I acknowledge my membership may be canceled or changed if at any time I fail to meet qualifications. I confirm that I own or have permission to use all submitted image and logos. I give Twenty & Oak authorization to use all submitted images. I understand that all features and benefits, and membership pricing levels of the Twenty & Oak platform are subject to change to meet market needs and requirements. I agree to comply with the Twenty & Oak Membership Agreement, Terms of Use, and Privacy Policy.

Signature:*

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Your Name:*

First NameLast Name

Your Email: *

example@example.com

Phone Number

Area CodePhone Number

Same as "your name" info entered above

Owner/Manager Name:

First NameLast Name

Title:

Manager. Owner, CEO

Owner/Manager Email:

example@example.com

Owner/Manager Mobile Number:

Area CodePhone Number

Same as "your name" info entered above

Billing Contact Name:

First NameLast Name

Billing Contact Email:

example@example.com

Billing Contact Phone Number:

Area CodePhone Number

Please verify that you are human*