MEMBERSHIP APPLICATION    
Contact: Robin Rush 513-642-5881    
Company Information    
Legal Business Name Tax ID #:
Doing Business As:

Product:

Address:
City: State: Zip:
Phone Ext:  

Mailing Address

City: State: Zip:
Business Type: Corporation Sole Proprietor Partnership
Website: website 
Contact Information    
Name: Title:  
Cell #: Drivers Lic# State:
Fax # SSN: DOB:
E-Mail:    
Payment Options      
Yes the Application Fee was paid directly to my Independent ITEX Representative   Amount:
OPTION 1 - Cash Fees will be billed to my credit/debit card every four-week cycle.    
Visa MC Discover AMEX    
Card Number: Expiration Date:  
Billing Address:
City: State: Zip:
Name on Card:
OPTION 2 - Fees will be deducted from my checking account every four-week cycle Will need a
voided check
Itex Representative will contact you to complete your application.
     

AGREEMENT:
I request to subscribe to the record keeping and administrative services of ITEX Corporation and to participate in the ITEX Marketplace. I have received the Member Agreement, the Marketplace Rules and the Privacy Policy, the terms and conditions of which are herein incorporated by reference, which govern the use of my ITEX account, and I agree on behalf of the
applicant and all authorized signatories to be bound by and comply with the terms and conditions of the Member Agreement, the Marketplace Rules and the Privacy Policy and any amendments thereto as may be posted on the ITEX website at www.itex.com . I have provided all the information on this application accurately, in good faith, and to the best of my knowledge. The undersigned has the authority to bind the applicant and all authorized signatories. This document, together with the Member Agreement, the Marketplace Rules, and the Privacy Policy, represents the complete agreement between the applicant and ITEX Corporation; there are no other representations made by ITEX Corporation. In the event of any disagreement, I agree to binding arbitration as specified in the Member Agreement. This agreement is not final unless and until this application is accepted by ITEX Corporation.


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