Click here to read and understand The Terms and Conditions. Type of Program* Premium Standard Name (Personal/Business)* Representative Name (Business) Representative Title (Business) Address (Street)* Address 2 City* State Zip/Postal Code* Country* Canada South Korea United States Phone Number* E-mail Address* Your Account Information (for Refund Purposes) Financial Institution* Account Number* Routing Number This agreement incorporates the attached terms and conditions which you confirm you have read and understood. You and Acumen West both agree to comply with the terms and conditions. By clicking the SEND button below, I hereby acknowledge that I have read, understand, agree to, and accept this agreement and the terms and conditions.* Client/Representative Print Name* Date* SEND
