GigCare Appointment

Please complete the new marketing representative sign up form with your information. You will receive an email confirmation containing your ID number, your personal website link, and your username/password to access the management area.

Company Name

Your Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Phone Number(Required)

Email Address(Required)

Date of Birth(Required)

Social Security Number(Required)

National Producer Number(Required)

Pick a Username(Required)

Pick a Password(Required)

Upload Your License(Required)

Upload your resume in .pdf, .doc or .docx format

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Upload Your Certification(Required)

Upload your resume in .pdf, .doc or .docx format.
If you have not yet completed your certification click here to complete.

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Agreement(Required)

ENROLLMENT SYSTEM ACCESS AGREEMENT

THIS AGREEMENT is between Iron Health and __________ ("Representative") and is effective as of the date acknowledged by Representative below. In consideration of the mutual agreements and representations set forth herein, the parties agree as follows:

Representative is an individual, partnership or corporation whose completed application has been accepted pursuant to the understanding that Representative is operating under an arrangement with an agency or upline representative that is an authorized partner of Iron Health ("Authorized Partner"). Only Representatives operating under an arrangement with an Authorized Partner may utilize the E123 enrollment system ("Enrollment System").

Representative is an independent contractor, conducting business for Representative's own account, and not as an agent or employee of Iron Health. Representative shall be responsible for payment of all applicable federal, state, and local taxes (including, but not limited to, Social Security taxes, unemployment taxes, and income taxes) and will abide by all applicable federal, state, and local laws. Representative agrees and understands that Representative cannot bind Iron Health or any of its provider companies by any promise or agreement, to incur any debt, expense, or liability in its name or account. Representative shall be free to exercise Representative's own judgment as to the persons solicited and the time and place of such solicitation.

Iron Health will issue an "Identification Number" after receipt of this Agreement. Representative acknowledges that this Identification Number must appear on all enrollments submitted by Representative in order to get proper credit for the sale.

Iron Health or its designated third party administration shall pay Representative's recruitment fees and/or commission as provided for in the recruiter fee or commission schedule hereof as complete compensation for all enrollment forms procured and for all services performed as required of Representative hereunder. Recruitment fees and commission are payable on the application fee. Commissions shall not include monies for administration fees. All commissions are paid as earned as set forth in the commission addendum. Commissions will be paid on the 15th of the month following the month in which the commission was earned.

No commissions shall be payable on any membership not accepted by the applicant or on any membership declined by Iron Health. In the event that Representative incurs indebtedness to Iron Health or its affiliates, Iron Health may offset against, and deduct from, any compensation due. Such indebtedness shall be a first lien against all such compensation.

Representative acknowledges that access to the Enrollment System and its resources is predicated upon Representative's affirmation that Representative has underwent sufficient and appropriate training by an Authorized Partner.

Representative hereby agrees for the duration of this Agreement, and for twenty-four (24) months thereafter, that Representative shall follow all processes and procedures set forth under Representative's arrangement with an Authorized Partner.

No forbearance or neglect by Iron Health to enforce any of the provisions of this agreement shall invalidate it or thereafter constitute a waiver of any of these provisions.

Either party may terminate this agreement upon (15) days prior written notice to the other party's last known address. Iron Health may terminate immediately for Cause. "Cause" is defined to mean:

Fraud or breach of any of the terms of this agreement;
Misrepresentation of programs offered by Iron Health or its affiliates; or Violation of any laws or any illegal act.

Iron Health retains sole discretion to determine what constitutes a breach, misrepresentation, or illegal act under this agreement.

If this agreement is terminated for Cause, Representative shall not be entitled to any further commission of any kind. Representative shall continue to be paid on any accounts placed with Iron Health for the life of that account.

Iron Health may offset any indebtedness by Representative against commission or overrides. Interest on any unpaid balance shall be 1.5% per month, subject to change upon notice by Iron Health. Collection fees on unpaid debts to Iron Health shall be at Representative's cost.

Commissions shall be paid on the 15th of the month, by direct deposit only, as long as Representative is active and does not violate any provisions of this agreement. This is the only interest Representative may have in the business after termination of this agreement. No assignment of this agreement on any compensation hereunder shall be valid without prior written consent by Iron Health. Unauthorized assignment will result in immediate termination of this agreement. Where authorized to do so by an upline, Iron Health may pay the Agent their Commission without the need to contract directly with the Agent themselves beyond this Enrollment System Access Agreement.

Iron Health shall have the right to audit the Representative's records related to this agreement at any time to ensure compliance with its terms.

Representative hereby agrees that the ledger accounts of Iron Health shall be competent and sufficient prima facie evidence of the state of accounts between parties hereto and the failure of Representative to object in writing to any statement of account furnished by Iron Health to Representative, within (90) days from the date such statement is furnished, shall render such statement a correct account as between Iron Health and Representative.

If any provision of this agreement is declared or found to be unenforceable, all other provisions shall remain in full force and effect.

If Representative is a corporate entity, the persons executing this agreement as officer of said corporation hereby agree and undertake the personal guarantee and satisfaction of all duties, performances and all obligations, including monies owed and to by such corporation, under this agreement.

Representative agrees to indemnify and hold Iron Health, its officers, directors, successors and assigns harmless from any claim, action, liability, loss, damage, or suit arising from the failure of Representative to abide by the training, processes, and procedures set forth under Representative's arrangement with an Authorized Partner, as well as any claims arising from the Representative's negligence or misconduct.

The laws of the State of Texas shall govern this Agreement. All disputes arising under this agreement shall be resolved in a court of competent jurisdiction located in Tarrant County, Texas, and any appellate court from any thereof. Each party irrevocably and unconditionally submits to the exclusive jurisdiction of such courts.

Representative agrees to accept periodic updates and information from Iron Health by email, fax or mail.

Other products may be added or commissions adjusted on new business by addendum.

[Signatures Page Follows]
f

IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed as of the date below by an individual who is duly authorized.

Iron Health

By: __________

Name: __________

Its: __________

Dated: __________

Representative

By: __________

Name: __________

Its: __________

Dated: __________

Check this box if you have read, uderstand and agree to the agreement

Legal Consent(Required)

Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures

Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically.

You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below.

Scope of Consent
By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below.

Paper Copies
You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies.

Withdrawal of Consent
You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below.

Withdrawing your consent, requesting a paper copy, or updating your contact information
You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices.

“Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address.

“Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy .

“Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number.

The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.

I agree to the terms and conditions.