I am an authorized agent, owner or employee of the above business and acknowledge that I have the authority to enter into a participation agreement with VGM and, to the best of my knowledge, all information provided is correct.
If VGM should discover that the information provided is not correct,
VGM has the right to cancel or amend our participation in any and all programs through VGM.
I also acknowledge that any current programs we desire to continue through a direct relationship have been disclosed
and I understand that we will not be allowed to participate in the VGM program relating to those direct programs.
Further, if VGM discovers that a program existed that was not disclosed above, we agree and authorize VGM that we
wish to remain on the VGM program. Once notified, I will cancel said direct agreement within 5 business days and agree
to repay any monies related to the undisclosed program(s).
By signing this application, I am authorizing VGM to enroll the business listed above in all programs related to the above
categories selected. I authorize VGM to contact all distribution companies listed within this participation agreement in order to obtain product level data reporting for the purpose of price deviations, volume allowances tracking and opportunity analysis. I agree to and acknowledge that VGM may receive financial consideration from certain program providers based on my participation through the VGM program.
I authorize VGM Club to collect rebates on my behalf to be distributed quarterly.
By submitting this form, Member hereby authorizes VGM Club to offset any sums due to member from VGM Club against any sums due to VGM Club.
VGM Club retains a portion of rebates earned for program administrative costs. A completed W-9 form must be received prior to the issuance of any rebate checks.