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:

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

Company Information





Applicant information



Additional Applicants?

Financial Institution Information


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