Discounted Affiliate Vendor Membership Individual/Business Name*Business Email Address* Phone Number*Fax NumberWebsiteBusiness Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Service and/or Product*Primary Contact Name First Last Contact Title*Contact Email* Enter Email Confirm Email Contact Phone*Choose Membership*$3,600 - Tier 1(Annual-D)$900 - Tier 1 (Quarterly-D)$300 - Tier 1 (Monthly-D)$1,200 - Tier 2(Annual-D)$300 - Tier 2 (Quarterly-D)$100 - Tier 2 (Monthly-D)Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Membership Terms I agree to the following terms: 1) 6Beds membership dues for one (1) year, payable by credit card and the member’s chosen payment frequency of monthly, quarterly, semi-annually or annually; 2) I understand that I can cancel the membership on or after the anniversary date; 3) Membership cannot be cancelled prior to the anniversary date. I acknowledge that the origination of automatic electronic payment to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card account and will not dispute the scheduled transactions with my credit card company; so long as the transactions correspond to the terms indicated in this authorization form. 6BEDS is a Mutual Benefit NON-PROFIT Corporation. Membership fees may be tax deductible (consult with your tax advisor) and are non-refundable.Vendor Member Signature* Share this:FacebookTwitterEmailLike this:Like Loading...