Platinum Member Marketing and Payment Agreement

Representative's Name *

Representative's Title *

Representative's Phone *

- Area Code Phone Number

Representative's E-mail *

Dear Member,
Barbara's Picks, LLC (“Barbara’s Picks” or “Our”), an Arizona limited liability company, is pleased to include: (Company Name), a (Category) company located at (Address) (“Member”, “You” or “Your”) as a recommended and preferred retail/wholesale resource. This Marketing Agreement (“the Agreement”) is comprised of the following: (1) the Marketing Agreement Terms and Conditions (Terms & Conditions); (2) a list of marketing benefits; and (3) our fees. By executing this Agreement You are also agreeing to accept the Terms & Conditions. When executing this document, please complete the information on the Recurring Payment Authorization form for monthly recurring billing.

Company Name *

Category *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Terms and Conditions *

Yes I agree to the Terms and Conditions

Schedule your payment to be automatically charged to your Visa, MasterCard, American Express or Discover Card. Just complete and sign this form to get started!

Recurring Payments Will Make Your Life Easier:
• It’s convenient (saving you time and postage)
• Your payment is always on time (even if you’re out of town)

Here’s How Recurring Payments Work:
You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated below each billing period. A receipt for each payment will be emailed to you and the charge will appear on your bank statement as an “ACH Debit.” You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

Please complete the information below:

Authorization and Acknowledgement *

I authorize Barbara’s Picks LLC to charge my credit card monthly for payment of my Barbara’s Picks membership. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Barbara’s Picks LLC in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the payment dates fall on aweekend or holiday, I understand that the payments may be executed on the next business day. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company so long as the transactions correspond to the terms indicated in this authorization form.

Platinum Membership

$249 per month + $99 Set Up Fee - 3 month minimum - Monthly thereafter $ 846.00

$249 per month - 6 month membership - No Set Up Fee - Monthly thereafter $ 1,494.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Company Contact

Platinum Member Marketing Agreement

Recurring Payment Form