This Customer Service Agreement is made by and between Rondesse Inc., hereinafter referred to as “The Company” and the Customer who submits his/her full name in the form below, hereinafter referred to as “The Named Member”, each a “Party” and collectively the “Parties”.

WHEREAS the Company, Rondesse Inc., owns “Rondesse,” a business venture that offers a collection of solutions and services, including, without limitation, for online security and scam prevention, mitigation, and reparations.

Whereas, The Named Member, shall be a natural person, executing this contract.

Whereas, the benefits of this contract may extend only to the Named Member or the specific company they are authorized to represent, contingent upon each service provider, specific to the subscription plan chosen by the Named Member.

NOW THEREFORE, in consideration of the premises and the mutual covenants set forth herein and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto covenant and agree as follows

BY SIGNING THIS AGREEMENT AND AGREEING TO THE TERMS AND CONDITIONS STATED HEREIN, THE NAMED MEMBER AGREES TO ALLOW THE COMPANY TO ACT ON THE NAMED MEMBER’S BEHALF TO ENFORCE THE FEATURES AND BENEFITS OF THE SUBSCRIPTION PLAN CHOSEN AND SPECIFIED BY THE NAMED MEMBER ON THE FORM BELOW. THE NAMED MEMBER MAY BE REQUIRED TO SIGN ADDITIONAL DOCUMENTATION WHICH WILL AUTHORIZE THE COMPANY TO SPEAK AND/OR SIGN ON THE NAMED MEMBER’S BEHALF.

Services: During the Term of this Agreement, the Named Member is entitled to the benefits listed on the Company’s website for the selected subscription plan. Benefits of Custom subscription plans are personally provided to you in writing, by the Company. It is important to note that this clause does not encompass cases that involve specific Scope of Work agreements, which are subject to separate terms and conditions

In applicable subscription plans, The Company may work on up to two (2) cases at a time relative to The Named Member. If a third (3rd) case is identified by The Named Member, it shall be queued to be addressed after one of the 2 cases is resolved. The Named Member may choose to escalate the third (3rd) case above one of the active cases by emailing or contacting their Tech Warehouse representative.

In enacting the benefits of this Agreement, a confidential standard case intake process shall be performed by a member of the Company’s staff to identify all relevant resources and thoroughly assess the necessary steps and measures to forge a resolution for the presented issues. The Named member agrees to actively participate in the disclosure of the required information, situations, conversations, and documentation pertaining to the case. This will serve as the Company’s foundation for providing recommendations for action to safeguard and preserve the Named Member’s assets, interests, information, data, and property, which shall be executed based on the Named Member’s sole discretion. Success projections may vary based on issues presented during the intake process. The Named Member understands that any refusal or delay in availing the Company’s services, or any decision to take actions that are not recommended and/or delaying recommended actions, may have an adverse effect on the Named Member’s ability to secure the full benefits of this contract. The Named Member will be assigned a staff person (“Concierge”) to work as a guide and the point of contact for all services provided by the Company and navigate the work the Company’s Partners.

Fees and Payment: All Terms are in United States Dollars (USD). Fees and Payment structure will be as specified in the Subscription Plan and the subsequent emails that will be sent upon the Named Member’s submission of the form below. The Named Member will receive a payment link to execute the payment.

ONCE PAYMENT IS RECEIVED, THE NAMED MEMBER IS NOT ELIGIBLE FOR A REFUND AT ANY TIME. PAYMENTS ARE DUE AT SIGN-UP AND WILL BE COLLECTED BEFORE ANY SERVICES ARE INITIATED ON BEHALF OF THE CLIENT UNLESS SPECIFIED OTHERWISE IN THE SUBSCRIPTION PLAN CHOSEN BY THE NAMED MEMBER IN THE FORM BELOW.

Should additional costs be deemed necessary outside of standard coverage specified in the subscription plan chosen by the Named Member in the form below, this will be discussed with The Named Member and subsequently considered an extra charge.

In the event that the Named Member is a victim of a scam and The Company is able to recover any amount, The Company is entitled to a minimum fee of 5% of the recovered amount as a recovery fee. If the Company deems it necessary, additional amounts or percentages may be negotiated and communicated to the Named Member. This fee is separate and distinct from the subscription fee and any additional costs deemed necessary under the subscription plan.

The subscription plan is designed to provide coverage for potential cases or issues that may arise during the term of the contract. If any existing cases or issues need to be addressed as part of the subscription, the Named member may be required to pay additional fees for these ‘at-need’ services. The Named member understands and agrees that failure to disclose any existing cases or issues at the time of subscription may affect the company’s ability to properly address these issues and may result in additional fees being applied retroactively.

Term:  This Agreement becomes effective upon receipt of the initial payment by The Named Member. The Agreement spans a term of twelve (12) months from the date of commencement (“Term”).

Minimum Commitment Period: The Named Member is obligated to a minimum commitment period of four (4) months for the selected plan, except in cases of customized plans, which may have distinct terms as detailed in such plans.

Extended Commitment for Specific Solutions: Despite the general commitment period for the selected plan, the Named Member must continue payments for Norton/IDIQ and Rocket Lawyer solutions for the entire 12-month Term due to their annual upfront payment structure. This obligation applies irrespective of the overall plan’s commitment period.

Starter Plan Obligations: The starter plan, comprising solely Norton/IDIQ and Rocket Lawyer solutions, necessitates a full 12-month payment commitment, aligning with the overall Term of the Agreement.

Scope of Work Agreements: Engagements falling under specific Scope of Work agreements are subject to their individual terms and conditions, which may override or supplement this Agreement’s terms.

Renewal and Termination: Absent a specified alternative in the subscription plan, this Agreement shall automatically renew for successive one-year periods. Termination of this Agreement prior to the completion of the Term may occur in accordance with the provisions detailed herein.

Termination: The Company reserves the right to terminate this Agreement during the Term (“Early Termination”) without cause or in the absence of a Default, effective thirty (30) days following the provision of Notice. The Named Member will not be held responsible for any fees if The Company initiates termination for reasons other than damage to the Company’s brand or The Named Member’s Payment Failure. The Named Member may terminate this Agreement after the expiration of the Initial Term by providing a 30 day written notice.

Should Early Termination be initiated due to The Named Member’s failure to make payments for two (2) consecutive months, or if The Named Member submits a notice of termination, the credit card on file for The Named Member will be charged for any past-due payments, as well as for the remaining period of the term, based on the subscription plan selected by “The Named Member” as outlined below.

In the event that the Company needs to engage collection services due to The Named Member’s failure to make payments, The Named Member will be responsible for the cost of these and related services, in addition to the outstanding amounts owed.

In cases where damage has been caused to The Company’s brand by an act or omission of the Named Member, The Company reserves the right to seek all available legal remedies, including but not limited to pursuing an injunction.

Member Access After Termination: Upon expiration of the Term (or any Renewal Term) The Named Member will lose all access to the benefits, and services provided by Company.

Renewal Option: The Named Member and Company shall each have the right, but not the obligation, to extend the Services for an additional term. Both parties understand that the Renewal Term shall commence immediately upon the expiration of the current term, unless the parties sign a new Agreement or an Amendment to this agreement, stating otherwise, at least 30 days before the expiration of the current term.

Non-Circumvention: During the Term of this Agreement and for 2 (two) years following its Termination for any reason, The Named Member agrees not to hire, solicit, or induce the termination of any employees of the Company without prior written consent from The Company. If this provision is violated, the Company reserves the right to pursue all available legal remedies available, including but not limited to seeking an injunction. The Named Member acknowledges that this Agreement is both fair and necessary to protect the legitimate business interests of The Company. It is further understood that if any part of this Agreement is found to be unenforceable by a court of law, the remaining parts of the Agreement will continue in full force and effect.

Confidential Information: The term “Confidential Information” shall include any and all information provided by one Party (the “Discloser”) to the other Party (the “Recipient”), whether through written, oral, visual of other means of disclosure, regarding the business, operations and assets of Discloser, and shall include, without limitation, research, financial information, customer, Client, and supplier information, formulas, price information, manufacturing plans and drawings, and documents, data, or information relating to devices, methods, materials, ideas, plans, processes, apparatus, designs, drawings, research, yields or specifications. Discloser shall retain all right, title, and interest in any Confidential Information disclosed to the Recipient. “Confidential Information” also includes all parts or copies of such information and any information derived therefrom. The term “Confidential Information” shall not include, however, any information that is:
(i) Disclosed by a third party to the Party receiving such information hereunder, and such third party has a right to make such disclosure and the Party receiving such information gives at least 30 days’ written notice to the other Party prior to using such information; or
(ii) Or shall become part of the public domain through no fault of the Party under an obligation not to disclose such information hereunder; or
(iii) Already in the possession of the Party receiving the information at the time it was disclosed, as evidenced by records kept in the ordinary course of such Party’s business, and such Party gives notice to the other Party within 10 days after the receipt of such information; or
Independently developed by the receiving Party without breach of this Agreement and without reference to any Information received by such Party hereunder.

RESTRICTIONS ON USE AND DISCLOSURE: The Named Member agrees not publish, disclose, release or divulge the Confidential Information, in whole or in part, to any third party (including without limitation to any agent, government agency, or customer) without the prior written consent of Discloser. The Named Member agree not to disclose Confidential Information to any parent, subsidiary or affiliate The Named Member unless those The Named Member have a “need to know” and agree in writing to be bound by the provisions of this Agreement.
The Named Member agrees to employ at least the same degree of care in protecting the Confidential Information as it employs in protecting its own most confidential information, but not less than a reasonable degree of care. Without limiting the foregoing, The Named Member agree not to copy any Confidential Information, except as may be required for the Discussions, and agree to store such Confidential Information in a secure place. The Named Member agree to ensure that Confidential Information is disclosed only to those of its employees who require access to such information in connection with the Discussions and have been advised of the confidentiality provisions of this Agreement.
The Named Member agrees to use the Confidential Information only in connection with the Discussions and agree to not use such Confidential Information for its own benefit or to Discloser’s detriment, including, without limitation, the development of competing products. Upon termination of this Agreement or request by Discloser, The Named Member agree to return to Discloser all Confidential Information, including all copies, derivatives, or summaries thereof.
The Named Member acknowledges and agree that this Agreement does not vest The Named Member with any rights in or to the Confidential Information or any related patents or patent applications respecting the Confidential Information or to license or otherwise acquire any rights in the Confidential Information or to utilize or exploit the Confidential Information in any manner, except as specifically provided for hereunder. Discloser makes no representation or warranty as to the accuracy or completeness of the Confidential Information provided to The Named Member. Discloser retains and owns all such rights and is allowing The Named Member to evaluate the Confidential Information in reliance on The Named Member’ agreement to maintain the confidentiality of the Confidential Information.

MISCELLANEOUS:

Equitable Relief: The Named Member acknowledges and agrees that money damages would be an inadequate remedy for its breach of this Agreement because of the difficulty of ascertaining the amount of damages that would be suffered by Discloser in connection therewith. Therefore, The Named Member agrees that Discloser shall be entitled to equitable relief, including injunction and specific performance, in the event of any breach of the provisions of this Agreement by the Named Member, in addition to all other remedies available to Discloser at law or in equity. Each Party agrees to waive or use its best efforts to waive any requirement for the securing or posting of any bond in connection with such remedy.

Litigation Expenses: The prevailing Party in any action to enforce this Agreement shall be entitled to reasonable costs and attorneys’ fees, including appeals therefrom.

Employee Undertakings: The Named Member agrees, upon Discloser’s request, to have its employees execute written undertakings to comply with the confidentiality requirements set forth in this Agreement. The Named Member shall be responsible for any unauthorized disclosure of the Confidential Information by its employees or agents.

Binding Effect; Jurisdiction: The provisions of this Agreement shall be for the benefit of and binding upon each of the Parties and their respective heirs, successors and permitted assigns and shall be governed by and construed in accordance with the internal laws of the State of Georgia. Any claim arising under this Agreement shall be prosecuted in a federal or state court of competent jurisdiction located within Cobb County, Georgia, and the Parties consent to the jurisdiction of such court and to the service of process by mail.

Protection of Personal Information: We recognize the importance of the privacy and protection of personal information. We have established policies and procedures designed to protect the Named Member’s personal information from unauthorized access, use, or disclosure. We will only use and disclose your personal information in accordance with our privacy policy and this Agreement.

Survival: The obligations set forth in this Confidentiality clause shall survive termination and remain in place for as long as any information remains Confidential.

INDEMNIFICATION: The Named Member agrees to defend, indemnify and hold Company, and its subsidiaries, affiliates, directors, officers, employees and agents (“Indemnified Parties”) harmless from and against all claims, damages, losses, suits, actions, demands, proceedings, expenses, and liabilities of any kind, (including reasonable attorneys’ fees incurred and/or those necessary to successfully establish the right to indemnification) threatened, asserted or filed (collectively, “Claims”) against the Company, to the extent that such claims arise out of or relate to (i) bodily injury or death to any person, (ii) loss, disappearance, or damage to property, (iii) any breach or alleged breach of any warranty or representation made by Company in this Agreement, (iv) the infringement or violation of any patent, copyright, trademark, trade secret or other proprietary right of a third party and/or (v) any act or omission to act of Company, its Subcontractors, or agents, except to the comparative extent that such Claims result from the negligent or willful acts of Company.

LIMITATION OF LIABILITY. TO THE MAXIMUM EXTENT PERMISSIBLE BY LAW, NEITHER PARTY SHALL BE LIABLE TO THE OTHER FOR ANY INDIRECT, CONSEQUENTIAL, INCIDENTAL, PUNITIVE, OR SPECIAL DAMAGES (INCLUDING, WITHOUT LIMITATION, LOSS OF PROFITS, LOSS OF DATA, OR LOSS OF USE) INCURRED BY THAT PARTY AS A RESULT OF ANY BREACH OF THIS AGREEMENT. THESE LIMITATIONS SHALL APPLY REGARDLESS OF THE FORM OF ACTION, WHETHER UNDER STATUTE, UNDER EQUITY, OR IN CONTRACT OR TORT, INCLUDING NEGLIGENCE, OR ANY OTHER FORM OF ACTION, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. THIS SECTION SHALL HAVE NO EFFECT UPON AND SHALL NOT LIMIT LIABILITY FOR ANY CLAIMS, LOSSES, OR DAMAGES FOR FRAUDULENT, CRIMINAL, MALICIOUS, OR UNDER ANY SECTION IN THIS CONTRACT REGARDING INDEMNIFICATION, LIMITATION OF LIABILITY, SEVERABILITY, AND/OR GOVERNING LAW.

THE COMPANY IS NOT A “LAWYER REFERRAL SERVICE” AND DOES NOT PROVIDE LEGAL ADVICE OR PARTICIPATE IN ANY LEGAL REPRESENTATION. THE COMPANY IS NOT A LAW FIRM OR A SUBSTITUTE FOR AN ATTORNEY OR LAW FIRM. THE COMPANY PROVIDES YOU ACCESS TO A TEAM OF ATTORNEYS AND IT IS THE ATTORNEY’S DISCRETION TO TAKE YOUR CASE.

THE COMPANY MAKES NO REPRESENTATION, GUARANTEE, OR WARRANTY (EXPRESS OR IMPLIED) AS TO THE LEGAL ABILITY, COMPETENCE, OR QUALITY OF REPRESENTATION THAT MAY BE PROVIDED BY ANY OF THE COMPANY’S EXPERT PARTNERS (LAWYERS, PRIVATE INVESTIGATORS, CERTIFIED ETHICAL HACKERS, ACCOUNTANTS), OUTSIDE OF THE BENEFITS OF THE SUBSCRIPTION PLAN CHOSEN BY THE NAMED MEMBER IN THE FORM BELOW.

THE NAMED MEMBER SHOULD NOT CONSTRUE ANY INFORMATION OR OTHER MATERIAL PROVIDED BY RONDESSE AS LEGAL, TAX, INVESTMENT, FINANCIAL, OR OTHER ADVICE. ANY CONSULT PROVIDED BY RONDESSE OR ITS PARTNERS, ASSOCIATES, OR AFFILIATES DOES NOT CONSTITUTE SOLICITATION, RECOMMENDATION, ENDORSEMENT, OR OFFER BY RONDESSE OR ANY THIRD-PARTY SERVICE PROVIDER TO BUY OR SELL ANY SECURITIES OR OTHER FINANCIAL INSTRUMENTS IN ANY STATE OR JURISDICTION IN WHICH SUCH SOLICITATION OR OFFER WOULD BE UNLAWFUL UNDER THE SECURITIES LAWS OF SUCH JURISDICTION. RONDESSE IS NOT A CERTIFIED FINANCIAL PLANNER/ADVISOR NOR A CERTIFIED FINANCIAL ANALYST NOR AN ECONOMIST NOR A CPA FIRM.

EXCEPT AS EXPRESSLY PROVIDED HEREIN, THE COMPANY MAKES NO WARRANTIES OF ANY KIND, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHERWISE, AND THE COMPANY SPECIFICALLY DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING, WITHOUT LIMITATION, ANY WARRANTIES OF MERCHANTABILITY, TITLE, NON-INFRINGEMENT, FITNESS FOR A PARTICULAR PURPOSE, OR WARRANTIES THAT MAY ARISE BY OPERATION OF LAW. THE COMPANY DOES NOT MAKE ANY WARRANTIES THAT THE SERVICES ARE FREE FROM ANY BUGS, ERRORS, OR OMISSIONS. EXCEPT AS EXPRESSLY PROVIDED HEREIN, THE SERVICES ARE PROVIDED “AS IS” WITHOUT ANY WARRANTY. ALL GUARANTEES AND BENEFITS ARE SUBJECT TO SERVICE PROVIDER CONDITIONS. THE FOREGOING DISCLAIMERS WILL APPLY TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW.

FORCE MAJEURE. A Party shall not be considered to be in default or breach of this Agreement, and shall be excused from performance or liability for damages to any other Party, if and to the extent it shall be delayed in or prevented from performing or carrying out any of the provisions of this Agreement, arising out of or from any act, omission, or circumstance by or in consequence of any act of God, labor disturbance, sabotage, failure of suppliers of materials, act of the public enemy, domestic or foreign terrorism, war, invasion, insurrection, riot, fire, storm, flood, ice, earthquake, explosion, epidemic, pandemic, breakage or accident to machinery or equipment or any other cause or causes beyond such Party’s reasonable control, including any curtailment, order, regulation, or restriction imposed by governmental, military or lawfully established civilian authorities, or by making of repairs necessitated by an emergency circumstance not limited to those listed above upon the property or equipment of the Party or property or equipment of others which is deemed under the Operational Control of the Party. A Force Majeure event does not include an act of negligence or Intentional Wrongdoing by a Party. Any Party claiming a Force Majeure event shall use reasonable diligence to remove the condition that prevents performance and shall not be entitled to suspend the performance of its obligations in any greater scope or for any longer duration than is required by the Force Majeure event. Each Party shall use its best efforts to mitigate the effects of such a Force Majeure event, remedy its inability to perform, and resume full performance of its obligations hereunder.

OTHER PROVISIONS.

Governing Law; Attorneys’ Fees. This Agreement shall be governed by the laws of the State of Georgia and The Named Member consents to jurisdiction and venue in the state and federal courts sitting in Georgia. The Named Member waives all defenses of lack of personal jurisdiction and forum non-convenience. The process may be served on either Party in the manner authorized to enforce by applicable law or court rule. If either Company or The Named Member employs attorneys to enforce any rights arising out of or relating to this Agreement, the prevailing Party shall be entitled to recover its costs, including reasonable attorney’s fees.
No Inadvertent Waiver. Failure of any Party to exercise its rights under this Agreement shall not be construed as a waiver thereof and shall not prevent said Party from thereafter enforcing strict compliance with any of the terms thereof. Binding Nature. This Agreement shall insure to and bind all successors, assigns, receivers, and trustees of the respective Parties hereto.

No Assignment. The Named Member acknowledges and covenants that it shall not sell, assign, transfer, pledge or encumber any of its rights or delegate any of its duties or obligations under this Agreement (by actual assignment or by operation of law, including without limitation through a merger, acquisition, consolidation, exchange of shares, or sale or other disposition of assets, including disposition on dissolution), without the prior written consent of the other Party, which consent shall not be unreasonably withheld. Notwithstanding anything to the contrary herein, Company may assign this Agreement to any of its subsidiaries.

Severability. If any court or governmental authority should determine that any clause or provision contained herein is improper, unenforceable, or violates any rule, regulation, policy, or statute, then that provision shall be enforced to the maximum extent permissible to effect the intent of the Parties, and to the extent, such provision or provisions shall be reformed without further action by the Parties hereto and only to the extent necessary to make such provision or provisions valid and enforceable when applied to such particular facts and circumstances and the remainder of this Agreement shall continue in full force and effect.

Amendment. The Company reserves the right, at its sole discretion, to modify or replace any part of this Agreement at any time. It is the responsibility of the Named Member to check this Agreement periodically for changes. The Named Member’s continued engagement with The Company following the posting of any changes to this Agreement constitutes acceptance of those changes. However, any changes to fees or charges applicable to the Named Member will be communicated personally.

If the Named Member disagrees with the changes to this Agreement, the sole remedy is to discontinue using The Company’s services, and notify The Company in writing. The Company will work with the Named Member to address their concerns and may, at its discretion, make an exception or provide a modification to the terms of their contract.

Company Corporation and Affiliates – Third Party Beneficiaries. The Named Member acknowledges and agrees that the benefit of certain Clauses of this Agreement is expressed to be not only for the benefit of the Company but also for the benefit of Company Corporation, Affiliates of Company Corporation, and/or licensors of Company Corporation. The Named Member acknowledges that each and any of the foregoing shall be entitled in its or their own right to require by The Named Member the due performance of each such provision as aforesaid and to this end, that Company is entering into this Agreement not only in its own right but also as an agent and trustee for each of Company Corporation, its Affiliates and/or licensors of Company Corporation, provided always that any action to enforce the rights or privileges of such Parties under or in connection with this Agreement or the Services (other than for an injunction, temporary restraining order or other similar equitable relief required to enforce the terms of this Agreement or to preserve the rights of such Party per applicable statutory or equivalent limitation periods) shall be instituted and prosecuted by Company on their behalf.

Compliance with Laws. Both Parties shall comply with all federal, state, country, and local laws, orders, rules, ordinances, regulations, and codes, including but not limited to those related to privacy and data.

Electronic Communications Protocol: Pursuant to the Electronic Signatures in Global and National Commerce Act (ESIGN) and the Uniform Electronic Transactions Act (UETA), this Agreement stipulates that all notifications, correspondences, agreements, and any other documents pertaining to this Customer Service Agreement shall be executed and transmitted electronically, save for those exceptions as outlined herein. This includes but is not limited to amendments, updates, and routine notifications that do not pertain to fee changes. The Named Member bears the responsibility to regularly review this Agreement for any such modifications or updates, as no separate electronic communication shall be issued for these adjustments, barring those involving alterations to fees or charges.

Requirement for Wet Ink Signatures: In accordance with legal requirements, wet ink signatures shall be necessitated solely for documents where electronic signatures are either not legally permissible or recommended. This includes:

• Official government documents mandating handwritten signatures.
• Documents requiring international legal recognition where electronic signatures may not be globally accepted.
• Any documents as specifically mandated by relevant state or federal legislation to require a handwritten signature.

Designated Addresses for Wet Ink Notices: For the transmission of documents requiring wet ink signatures under legal stipulations, the following addresses shall be used. It is incumbent upon each Party to timely notify the other of any alterations to their respective addresses designated for these notices:

Address for Notices. 

The Company:
Contact: Tom Phillips
Address: 3698 Bethelview Rd, Ste A202, Cumming, GA, USA, 30040
Phone Number: +1-646-968-0307
E-mail address: corporate_leadership@rondesse.com

With Copy to
Contact: Chelsie Campbell
Address: 8635 West Sahara Avenue, Las Vegas, NV 891117
E-mail address: justice@rondesselegal.com

The Named Member :  (please submit your information via the form below)

Notices shall be deemed given on the day deposited in the United States mail (postage prepaid, certified or registered, return receipt requested) or sent by a recognized national or international air express courier with charges prepaid or received via a certified secure electronic document signing platform.

ENTIRE AGREEMENT. This Agreement published on this webpage, including the form below, contains the entire agreement between the Parties with respect to the subject matter hereof and supersedes all oral understandings, representations, prior discussions, and preliminary agreements. Any representations, warranties, promises, or conditions not expressly contained in this Agreement shall not be binding upon the Parties. This agreement does not constitute an offer by Company and it shall not be effective until the form below is properly filled out and the Company receives payment from the Named Member.