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Pivotal Wealth Agent Registration

First Name: *
Middle Name:
Last Name: *
Date of Birth: *
ex. MM-DD-YYYY
SSN: *
ex. XXX-XX-XXXX
Company or DBA:
Tax ID or EIN:
ex. XX-XXXXXXX
Job/Position: *
School Name:
District:
Email: *
Confirm Email: *
Password: *
Confirm Password: *
Cell Phone: *
ex. XXX-XXX-XXXX
Alt Phone:
ex. XXX-XXX-XXXX
Address: *
City: *
State: *
Zip: *
Upline 1 Number: *
ex. PW00001
Upline 1 Percent: *
 
Upline 2 Number: *
ex. PW54321
Upline 2 Percent: *
 



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ACH Deposit Information

Account Name: *
Account Type: *
Account Number: *
Routing Number: *

W-9 Information

Payment Details

Agent registration fee:

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Currently accepting the following cards:

Here are some of the ways Pivotal Wealth protects your information:

  • Our website uses 256-bit Secure Socket Layer (SSL) encryption to transmit your information.
  • Your financial information is never divulged to anyone.
  • All transactions are processed by a Payment Card Industry (PCI) Level 1 compliant processor.
  • We do not store your credit card information.
Enter your credit card information: *

Welcome to Pivotal Wealth

Congratulations!
Welcome to the team! Your registration is now being processed. Your agent registration fee in the amount of $179 will be billed in two weeks.

Your Agent ID is .
Required Fields:
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