DWP VIP IP BLUEPRINT FUNDING MEMBERSHIP APPLICATION

This Form is the Official Membership Application for

DWP VIP IP BLUEPRINT FUNDING

Before completing this form, be sure to have the following information handy:

Secretary of State Certification of Authorization & Articles of Organization
Your Organization's Department of Treasury Tax ID Registration Letter
Your Organization's Operating Agreement
Secretary of State Letter of Good Standing
Email addresses/names of people authorized to make decisions
VOIDED Check for Business Checking Account
Financial Institution Full Address & Phone Number
Experian Credit Score
Last 4 of SSN#
Government Issued Photo ID (Driver's License, Passport, Voter's Registration)
Proof of Address (Utility Bill, Bank Statement, etc.,)

Applicant information

First Name *

Last Name *

Company Title

Percentage of Ownership Interest *

Address *

City *

State *

Phone Number *

Email Address *

Experian Credit Score *

Last 4 Numbers of SSN *

Government Issued ID (Driver's License, Passport, etc.,) *

Proof of Address (Utility Bill, Bank Statement, Voter's Registration - ALL edges of image must be noticeable) *

Additional Applicants?

Add another?

Financial Institution Information

Name of Financial Institution? *

Financial Institution Address *

City *

State *

Zip *

Voided Check (Business Checking Account ONLY - Personal Checking Accounts WILL NOT Be Accepted) "OR" Financial Institution Proof of Business Checking Account Routing & Account Numbers * 🛈

Confirmation

Checking the box below indicates agreement to submit DWP VIP IP BLUEPRINT FUNDING Membership Application fees in the amount of $1,000.00 payable in a ONE TIME lump sum payment "if" my company is NOT CURRENTLY a DWP Member with a previously arranged PAID Membership Agreement / Contract on file. *

I accept and agree

Checking the box below indicates agreement to submit DWP VIP IP BLUEPRINT FUNDING Membership Contributions in the amount either $1,000.00, $2,000.00, $3,000.00, $4,000.00 "or" $5,000.00 payable as a ONE TIME lump sum payment prior to January 25th, 2021 (whether my company identifies as a Non-Member "or" DWP-Member Business). Checking the box below also indicates my understanding that my DWP VIP IP BLUEPRINT FUNDING Membership Contribution will be replenished prior to the end of each phase of my company's 6 month DWP VIP IP BLUEPRINT FUNDING Membership payable via direct deposit to the financial institution on file for my company's business checking account. *

I accept and agree

Checking the box below indicates agreement to attend ALL mandatory member meetings in a punctual fashion and submit appropriate accounting, invoicing and intellectual property transactions whether my company identifies as a Non-Member "or" DWP-Member Business. Checking the box below also indicates my understanding that any deviation of previously agreed to terms and conditions are grounds for immediate termination of membership. A general membership termination notification via electronic mail will be sent within 1 business day following termination; explaining the delivery of a detailed written explanation of membership termination accompanied by the replenishment of contributions (minus the cost of FedEx delivery fees) within 10-15 business days delivered via FedEx to the business address on file. Additional terms and conditions for breach of contract apply (see DWP VIP IP BLUEPRINT FUNDING SA & AFFIDAVIT for details). *

I accept and agree

Checking the box below indicates agreement to follow the company's terms, security agreement and conditions of use. *

I accept and agree

Principal Company Representative Signature *

clear

DWP VIP IP BLUEPRINT FUNDING MEMBERSHIP APPLICATION

Company Information

Applicant information

Financial Institution Information

Confirmation