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Agent Registration

 AFTA Plan Agency Registration Application

This is not an application for the AFTA assurance plan. If you want to purchase AFTA, please contact an agent.

Company Name:  Email: 
Phone: Fax:
Address: City:
State: Zip:
MC #: Contact:
Paypal Email:
Virtual Terminal Users IMPORTANT: Please provide the first and last names of all personnel that will be doing payment processing on behalf of customers using credit cards. It is recommended to have different users for control and administrative purposes. At least one name is mandatory. Others can be added later

YOUR LOGO: Please provide a logo you want us to include on your communication pages, links and banner by sending it as an attachment or link to our support team. if you do not have a logo and want us to create a temporary image please request that in your email.
Terms and Conditions 

I confirm that you have read and understood the AFTA plan terms and conditions above    

 

 

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