TAILOREDCLUB PORTAL

Agent Registration

COUNTRY *

LEGAL FIRST NAME *

LEGAL LAST NAME *

PREFERRED FIRST NAME *

PREFERRED LAST NAME *

Social Security Number *

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PREFERRED FIRST NAME *

PREFERRED LAST NAME *

PERSONAL EMAIL ID *

PHONE NUMBER *

You can modify your corporate email address

Your corporate email ID is:

@TailoredClub.com

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ADDRESS *

CITY *

STATE *

ZIP *

Please provide us your banking information so we can transfer your monthly commission

BANK NAME *

BANK ACCOUNT *

IBAN *

ABA NUMBER *

SWIFT NUMBER *