New Consultant Information

(You must be 18 years of age or older to become a Consultant) Fields marked with * are required
First Name: 

*

Business Name: 

FID# (required if Business Name supplied)

* 

Date of Birth: (mm/dd/yyyy) 

*

* 

Home Phone: 

Business Phone:  Mobile Phone:   

* 

Last Name: 

*

SSN#    

Email: 

Shipping Address for Starter Kit (No PO Boxes allowed for Shipping Address)
* 

Address 1: 
Address 2:       

* 

City: 

State: 

*

*

Zip:    

Note: Shipments to Puerto Rico have an additional charge of $35.00 and shipments to the Virgin Islands have an additional charge of $100.00.

Power Zone Access

Power Zone is Ambit’s FREE online office available to all Ambit Marketing Consultants. Please specify a password for your Power Zone Account.
Password:

Personal Website. Obtain your own Ambit Energy Personal Website for only $24.95 per month. It counts as 2 customer points and it’s a powerful businessbuilding tool! It only takes a few minutes to build and publish.

 Personal Website. $24.95/Month (Plus tax)
Personalize Your Domain
Personalize your domain by choosing a unique web handle. Your web handle can be any single word or phrase you want including your name. It’s best to
keep your web handle simple and memorable so your prospects can find your site easily. Web handles are limited to 20 characters and cannot include spaces
or punctuation. http://yourname.ambitenergy.biz and http://yourname.joinambit.com
First choice: 

Second Choice: 

Third Choice:    

YOUR FIRST AVAILABLE CHOICE WILL BE RESERVED. 

Independent Consultant Sign-up Options (Credit Card Only) 
 Ambit Marketing Consultant: $429 
Marketing Consultants are Independent Consultants who choose to enroll in the optional Ambit Energy Support and Services Program. Any Marketing Consultant
who purchases the optional Ambit Energy Support and Services Program may cancel in writing within 3 days of the date the MC Application and Agreement is
received at Ambit Energy (Start Date) and will receive a full refund.
 Ambit Affiliate Partner: $99 
 
Affiliate Partners are Independent Consultants who choose to enroll in the optional Ambit Affiliate Program. This program provides ongoing commissions to the
Affiliate based on the number of customers who sign up and pay their energy bill on a monthly basis. The $99.00 fee includes both the affiliate position and website
access. Ambit Affiliate Partners cannot recruit Independent Consultants or other Affiliates.
 Ambit Single State Consultant - Connecticut: $199.00 with $99 annual renewal 
 
As a Single State Consultant (SSC), you’ll be enrolled as an Independent Consultant for Ambit Energy, with the ability to sign-up customers and recruit Independent
Consultants. This program provides bonuses on personal Connecticut customer gathering and ongoing commissions based on the number of Connecticut customers
that sign up and pay their energy bill on a monthly basis. You’ll have access to a range of consultant support services.

Billing Information:   
Card Type:  American Express  Discover  Master Card  Visa
Card Number   

Expiration Date

 Signature:   
Date:
    

I agree that as an Ambit Energy Independent Consultant, I am an independent contractor, and not an employee, agent, partner, legal representative, or franchisee of Ambit Energy. I UNDERSTAND THAT I SHALL NOT
BE TREATED AS AN EMPLOYEE OF AMBIT ENERGY FOR FEDERAL OR STATE TAX PURPOSES. I have carefully read and agree to comply with the Ambit Energy Independent Consultant Policies and Procedures, The
Ambit Energy Independent Consultant Application and Agreement, The Ambit Energy Guide to Compensation, and The Ambit Energy Privacy Policy, all of which are incorporated into and made a part of this Consultant
Application & Agreement. I understand that the Independent Consultant Application and Agreement, Independent Consultant Policies & Procedures, and Privacy Policy may be amended from time to time, and I agree that
any such amendment will apply to me. Notification of amendments shall be published in official Ambit Energy materials. The continuation of my Ambit Energy independent business or my acceptance of commissions,
bonuses or other benefits shall constitute my acceptance of any and all amendments. I understand that I have the right to terminate this Agreement at any time, with or without reason. I understand that such termination
must be in writing. I understand and agree that Ambit Energy may terminate this Agreement at any time, with or without reason, upon written notice to me. BY SELECTING ONE OF THE ENROLLMENT OPTIONS ABOVE,
I CERTIFY THAT THE INFORMATION PROVIDED IS ACCURATE. I UNDERSTAND THAT FAILURE TO PROVIDE AMBIT ENERGY WITH A CORRECT NAME AND SOCIAL SECURITY NUMBER MAY SUBJECT ME TO
BACKUP WITHHOLDING ON ANY PAYMENTS AMBIT MAY MAKE TO ME AND I MAY BE SUBJECT TO PENALTIES IMPOSED BY GOVERNMENT TAX AGENCIES. I ALSO AGREE THAT I HAVE READ AND AGREE TO
BE BOUND BY THE TERMS OF THE FOREGOING AGREEMENTS.