AI AGENT ANNA PROGRAM PRO-MEMBERSHIP REGISTRATION FORM

< GO BACK
CLIENT AI DIGTIAL MARKETING AGENT ANNA PROGRAM, PRO-MEMBERSHIP REGISTRATION FORM

SMART AI MEDIA GROUP
Business Name:*
Full Name:*

First NameLast Name
Business Address:*
Email*
example@example.com
Contact Number:*
Enter Your 1st Designated Geo Location:*
e.g. Manchester, Liverpool, Oldham, Preston, etc...
Enter Your 2nd Designated Geo Location:*
e.g. Manchester, Liverpool, Oldham, Preston, etc...
Enter Your 3rd Designated Geo Location:*
e.g. Manchester, Liverpool, Oldham, Preston, etc...
I accept the terms & conditions and I agree that my Digital Signature and Typed Name below can be used as a digital representation of my signature to that fact.

Confirm
I also give consent to the £499 Per Month Direct Debit Setup Via Stripe Payment Portal

Confirm
I acknowledge that the minimum term is for Six Months and then the payment will move over to on-going 30 Day Rolling Service.

Confirm
Your Digital Signature*

Powered by Jotform SignClear
To accept, type your in your Full Name*
Please note: Once you click the "Continue" button, a pop-up box will appear with a few options. Please click on "Set-Up £499 Monthly Membership". You will then be redirected to the Stripe payment portal.

Within 24 hours of registering, you will automatically receive your Direct Debit setup confirmation and Your Authorisation Code via email.

You will need Your Authorisation Code in order for SMART AI AGENT ANNA TO APPROVE YOU WORK.
Should be Empty:

CLIENT AI DIGTIAL MARKETING AGENT ANNA PROGRAM, PRO-MEMBERSHIP REGISTRATION FORM