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Published by Juli Becker
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Published by: Juli Becker on May 27, 2012
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ICR Enrollment Form 1-14-2011-3 Page 1 of 2
Terms and Conditions:
Please accept this application to become an Independent Collector Representative (ICR) for Numis Network,LLC (Numis). I have read, understand, and agree to abide by the provisions set forth in this Application & Agreement, the Policies &Procedures, and the Compensation Plan. I understand that these documents constitute the entire Agreement of the parties and thatthere are no other agreements either oral or written between the parties.I certify that neither Numis nor my enroller or sponsor has made any claims guaranteeing me any success in this program eitherthrough sales or recruiting, and that any profits or earnings that I might expect will be solely from my efforts as an ICR through theCompensation Plan. I understand that I am not required to purchase the
Fast Track Collector’s Kit
or become a Numis customer tobecome an ICR
. Terms and Conditions continued on page 2.
I understand that my purchase of the
Fast Track Collector’s Kit
is NONREFUNDABLE after 10 days from the date of thisAgreement.
 _________________________________________________ _________________________ Signature DatePlease destroy this form after use! It is against Numis policies and credit card regulations to save the credit card information on thisform in any manner. New ICRs are required to agree to Terms and Conditions electronically upon first login to back office.
APPLICANT INFORMATIONFirst Name Last NameCompany Name (Requires a business checking account. Compensation will be paid to this name.)Shipping Address (no P.O. Boxes) City State ZipPhone Email Social Security # or Tax IDCREDIT CARD INFORMATIONAmex MC Visa Disc (Please circle one)Card Number Expiration Date Security CodeName on CardBilling Address (if different)WEB SITE INFORMATIONReplicated Site Name PasswordPLEASE SELECT ONE OF THE OPTIONS BELOW
Associate Option: The Associate Numis SuccessSystem: $75.00
plus tax & shipping
The Associate Numis Success System includes:
Professional Starter Kit w/ Printed Sales Aids
Back Office Business Center 
Automatic Enrollment in the Silver Coin of the MonthClub
Websites: Shopnumis.com, Numisnetwork.com,Numisone.com
Star Builder Training System
$109.95/month + tax & shipping for Silver Coin of theMonth Club$9.95/month for online services
Executive Option: The Associate Numis SuccessSystem
plus The
Fast Track Collector’s
for a total of
plus tax and shipping
Fast Track Collector’s Kit
Your First MS70 Silver Coin
Personally Customized Forever Crystal
Graded Coin Attaché Case
Coins Are Cool
Educational Videos
Coin Grading Certificate to have 5 coins gradedby ANACS
400 Qualifying Volume & 60 Binary Volume
Additional Compensation Eligibility
ICR Application & Agreement-Must Be Entered Online By Enroller--Do Not Send To Numis-

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