2008 XDL Corporate Contingency Program Online Registration Form

2008 XDL Corporate Contingency Program
Online Registration Form

This form collects basic information from our corporate partners that allows us to set up and administer a contingency program. For more information on the program itself, please visit the contingency page on the XDL website. Once the form is completed it will be reviewed by us, we will contact you and then run the $500 administration fee.

Registrant Information

First Name
Last Name
Company
Address
City
State
ZIP
Phone # w/ area code
E-mail

Eligibility Criteria

Please specify what requirements you will be placing on riders to be eligible for your program. This can include running stickers, using your product or other.

Payout Information

Please specify what rewards a rider can expect. This can be product, cash or other.

Payment

Form of Payment

Credit Card Number
Expiration Date (MM/YY)
CCV Number
Name on Card