Registration

Affiliate Information
(* Indicates the required fields)

This information will be used to place you in the beSure Affiliate that suits you best.

Please indicate your industry

Which Affiliate are you interested in joining?

Which beSure Partner introduced you to our organization?

Personal Information

First Name*

Last Name*

Preferred Name

Mobile Phone (XXX) XXX-XXXX *

Date of Birth(MM/DD)*

Preferred Email Address*

Your Headshot (max. file size 2mb)

No file selected.

Business Information

Company Name *

Business Phone Number *

Street Address *

Suite

Company Website

City*

State/Area *

Zip Code*

Please upload your business card here (max. file size 2mb)

No file selected.

Experience

What is your position in the company?!

How long have you owned/worked for this company?!

How long have you worked in this industry? !

Is this your full-time, primary occupation?!

Are you currently licensed, bonded and/or insured to meet the requirements of your occupation? !

Please list any professional licenses, degrees, credentials or achievements you have that support your current occupation. !

Are you currently a member of any business network or organization that allows only one member per Business Category (BNI, LeTip, etc.)? If so, please provide the name of the organization. !

Profile/Social Media Information

Please take a few minutes to provide this information so we can complete your profile upon approval of your application. This information will allow us to tag you in posts that will help your business grow!

(please fill in complete format http://www.abc.com)

Facebook URL(business page if available)

Instagram Account (business account if available)

LinkedIn URL

YouTube Channel URL

TikTok Username

Where do your clients submit reviews for your business?
You can do multiple select and type as well.

Application Requirements

Please check off each statement below to acknowledge you have read, understand and agree to the beSure application requirements.

Please confirm you have received a copy of the beSure Guidelines, and have read, understand and agree to follow the Guidelines as an Partner of beSure.

Yes, I have read, understand and agree to follow the beSure Guidelines.

Please confirm that you have read and understand the beSure Scorecard and agree to achieve 1000 points per month, through various activities and contributions, and should you fall short of your 1000 point requirement for three consecutive months your membership will be terminated.

Yes, I have read, understand and agree to the guidelines surrounding the beSure Scorecard

Please confirm that as a new Partner you will complete your online profile within seven days.

Yes, I will complete my online profile within seven days

Please confirm that as a new Partner you will select a role or responsibility within your Affiliate.

Yes, I agree to take on a role or responsibility within my Affiliate

The goal of beSure is to provide its Partners with the structure they need to become better business people, increase revenue and achieve a positive source of business referrals within their local community. To achieve this success, we ask that our Partners have the discipline to follow our system and participate when required to do so. Your engagement and participation will certainly provide you with the biggest benefit as an Partner of beSure.

I agree!

Investment

Please choose your Preferred investment in the beSure organization. Members following our system have received average revenue in excess of $10,000 with some members receiving revenue in the hundreds of thousands of dollars! (this is not a guarantee and your individual results will vary based on business category, personal engagement and other factors)

By choosing a membership term below you agree that you are entering into a contract for the term of your choice. Should you vacate your membership in beSure or if your membership in beSure is terminated due to your failure to maintain minimum requirements, you will be charged for the full term of your membership and will be billed periodically until your Investment is paid in full.

I have read, understand & agree to the terms of membership as described above.

1-Year Membership

$59 Twelve Monthly Payments

$149 Four Quarterly Payments (15% Savings!)

$499 Single, One-Time Payment (29% Savings!)

2-Year Membership - BEST VALUE!

$49 Twenty-Four Monthly Payments

$119 Eight Quarterly Payments (15% Savings!)

$799 Single, One-Time Payment (29% Savings!)

Payment/Billing Address

Please provide your Billing Address here. For security purposes, a representative from beSure will call you to accept your payment over the phone. Thank you!

Use Business Address as Billing Address

Street Address

Suite

City

State/Area

Zip Code

Disclaimer: I attest that the information provided in this application is true and accurate to the best of my knowledge. I understand that if my application is approved by beSure and I am selected as a Partner, I will be charged for my entire chosen membership term either one-time, quarterly, or monthly based on my selection above.

I also attest that I have read and understood BeSure Guidelines & BeSure Activity Scorecard.

* Indicates the required fields

Partner Application

Affiliate Information
(* Indicates the required fields)

Personal Information

Business Information

Experience

Profile/Social Media Information

Application Requirements

Investment

1-Year Membership

2-Year Membership - BEST VALUE!

6-Month Membership
for current, paying members of other networking organizations

proof of active, paid-in-full membership required

Payment/Billing Address

Partner Application

Affiliate Information (* Indicates the required fields)

Personal Information

Business Information

Experience

Profile/Social Media Information

Application Requirements

Investment

1-Year Membership

2-Year Membership - BEST VALUE!

6-Month Membership for current, paying members of other networking organizations

proof of active, paid-in-full membership required

Payment/Billing Address

Affiliate Information
(* Indicates the required fields)

6-Month Membership
for current, paying members of other networking organizations