FLMMD Sales Representative Sign-Up FormThe information you provide on this form is solely for the use of flmmd.com and will be treated with the utmost confidentiality. We do not share, sell, or disclose your personal or professional details to any third parties without your explicit consent. Your privacy and data security are our priorities.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Email *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Drivers License or State ID (Proof of age requirement) Click or drag a file to this area to upload. Please select preferred method of paymentVenmoCashappZelleCheck via MailPayment Info for selected methodflmmd.com Sales Representative Terms and Conditions By becoming a Sales Representative for flmmd.com, you agree to the following terms and conditions: Representative Responsibilities: You will actively promote and refer doctors to flmmd.com as per our established guidelines. You will accurately represent the services and terms provided to doctors on our platform. Age Requirement: You must be 18 years of age or older to become a Sales Representative for flmmd.com. Compensation: Compensation of $500 will be paid to you for each doctor successfully added to the flmmd.com platform. Doctors must meet specific criteria for you to be eligible for commissions, including being licensed and registered with the Florida Office of Marijuana Use Registry. Payment Timing: Compensation will be paid to you after the referred doctor has been successfully added, verified, and has been on the flmmd.com platform for 30 days. Patient Compensation: Doctors on the flmmd.com platform receive compensation for patient appointments and renewals as detailed in our program. Confidentiality: You agree to keep any proprietary or confidential information provided by flmmd.com confidential. Compliance with Laws: You will comply with all applicable laws and regulations in your activities as a Sales Representative. Payment and Reporting: Payments will be made as per the agreed-upon schedule and method. You agree to promptly report any issues or discrepancies related to your compensation. Termination: flmmd.com reserves the right to terminate your role as a Sales Representative at any time, with or without cause. Independent Contractor Status: You acknowledge that you are an independent contractor and not an employee of flmmd.com. Modification of Terms: flmmd.com may modify these terms and conditions at any time, and such modifications will be effective upon posting on our website. Governing Law: This agreement shall be governed by and construed in accordance with the laws of the state of Florida. Entire Agreement: These terms and conditions constitute the entire agreement between you and flmmd.com regarding your role as a Sales Representative. By checking the "I agree" box, you confirm that you have read, understood, and agreed to abide by these terms and conditions in your capacity as a Sales Representative for flmmd.com. *I agree to the following termsSignature * Clear Signature Date of Agreement *Submit