ELECTRONIC SIGNATURE VERBIAGE

Chalky & Company

ICC AGREEMENT

Section I:                     Acceptance of the Agreement

Welcome to the Chalky & Company business. Please read the Chalky & Company ICC Agreement and Policies and Procedures carefully, collectively referred to as “ICC Agreement.”

Section II:                    AutoShip Program

Chalky & Company operates with an optional autoship program.  The program is automatically renewable each month with a credit or debit card maintained on file with Chalky & Company. The ICC may make adjustments to their autoship subscription in the back office of the Chalky & Company website. Cancellation requests will be effective in the calendar month in which Chalky & Company receives written notice unless the debit has already been processed. If the notice to cancel is received after the debit has been processed, the cancellation will be effective in the following calendar month.

Section III:                   E-Sign Notice- Consent to Electronic Record

E-Sign, the Electronic Signatures in Global and National Commerce Act (15 U.S.D. 7001, et seq.), requires that you consent to entering into an electronic agreement with Chalky & Company before an Chalky & Company ICC Agreement can be executed. Please read the following information carefully:

  • If you enter into an online ICC Agreement with Chalky & Company, you will not be required to submit a paper application. An electronic record will evidence the entire agreement between you and Chalky & Company. However, you must consent to the use of an electronic record and must read the Chalky & Company Terms of Use, Chalky & Company Policies and Procedures and the Chalky & Company Compensation Plan, and electronically acknowledge below that you have read these documents.
  • To access these documents and submit your online ICC Application, you will need a personal computer or Mac with Internet access and operational Internet browser software.

 

By clicking on “I agree” below, you consent to the use of electronic records evidencing your agreement to the Chalky & Company Terms of Use, Policies and Procedures and the Compensation Plan of the Chalky & Company ICC Agreement. If you click on the “I Decline” box, the enrollment process will be terminated and you will be returned to the Chalky & Company Home page.

 

Section IV:                   IRS W9 Information

The Tax ID number must match the name as shown on your income tax return to avoid backup withholding. For individuals, this is your social security number.

Please verify the information submitted on your enrollment form. If correct, acknowledge by checking the box below, which will serve as your digital signature. For further information, please see the official IRS W9 form instructions: http://www.irs.gov/pub/irs-pdf/fw9.pdf

Under penalties of perjury, I certify that:

  • The information submitted is correct
  • You are not an exempt payee (generally, individuals, sole proprietors are not exempt from backup withholding)
  • The IRS has not notified you that you are currently subject to backup withholding
  • I am a U.S. citizen or U.S. resident alien (individual/sole proprietor)

I consent to the use of electronic records and have read, understand and agree to the Chalky & Company ICC Agreement and Policies and Procedures.