Representative Enrollment

Welcome to Supergized! We look forward to having you as a business partner! Please complete the following steps to complete your enrollment.

Thank you for signing up

You may sign up to be a representative in one of several forms. You may sign up as a(n):

  • Individual - Please have your contact information and Social Security Number ready.
  • Sole Proprietorship - Please have your legal business name, contact information and Social Security Number or Employer Identification Number ready.
  • Corporation, Partnership or LLC - Please have your legal business name, contact information and Employer Identification Number ready.

Advisor Package
$109 kit price includes:

Sign up fees $59 one-time fees
$35 monthly fees for website
$15/month for virtual office
Total due at sign up $109
Total billed each month $50
  • Free first month of your Online Store ($50 value)
  • Enables you to Qualify for all referral opportunities right away
  • Back office tracking software and full corporate support
  • Product marketing & Business opportunity website, Back Office

Manager Package
$179 kit price includes:

Sign up fees $129 one-time fees
$35 monthly fees for website
$15/month for virtual office
Total due at sign up $179
Total billed each month $50
  • Free first month of your Online Store ($50 value)
  • Qualifies you for Manager compensation and referral bonus
  • Back office tracking software and full corporate support
  • Product marketing & Business opportunity website, Back Office
Contact Information

Please enter the contact name for your position. Do not put a business name, nickname, or initials. Only populate a legal first and last name.

First Name* :

Last Name* :

Email Address* :

Confirm Email Address* :

Physical Address* :

Apt.,Suite#,Building#, etc :

City* :

State or Province* :

Zip or Postal Code* :

Country* :

Time Zone* :

Work Phone* :

For Example: 123456789

Mobile Phone* :

For Example: 123456789

Choose Your Carier* :

New Password* :

Retype Password* :

Co-Applicant information (optional):

First Name :

Last Name :

Taxpayer Identification

Enter your Taxpayer Identification Number (TIN) in the box below, and confirm your TIN by typing it again in the 'Confirm Tax Identification Number' field. For individuals, this is your social security number (SSN). However, for the resident alien, sole proprietor, or disregarded entity, see the Part 1 instructions found on page 3 of the W-9 instructions found at . For other entities, it is your employer identification number (EIN). Do not include dashes in the SSN or EIN. Note: if the account is in more than one name, see the chart on page 4 of the W-9 instructions at for guidelines on whose number to enter.

This is a :

Social Security Number* :

Confirm Social Security Number* :

Please indicate your business type :

Tax ID Confirmation

* Under penalty of perjury, I certify:

1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3) I am a U.S. person (including a U.S. resident alien).

If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return then you must check this box.
For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See full instructions on Page 4 of the W-9 form at

Backup withholding certification

Right to Cancel Information

You may CANCEL this transaction, without any penalty or obligation, within THREE (3) BUSINESS DAYS from the above date (Five days for Alaska residents).

If you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instrument executed by you will be returned within TEN (10) BUSINESS DAYS following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be canceled.

If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this contract or sale, or you may, if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk.

If you do make the goods available to the seller and the seller does not pick them up within Twenty (20) days of the date of your Notice of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so, then you remain liable for performance of all obligations under the contract.

To cancel this transaction, email or deliver a signed and copy of this Cancellation Notice or any other written notice to: NO LATER THAN MIDNIGHT of the third business day following the date set forth above.

Terms and Conditions

1. I agree to conduct this transaction with Supergized electronically and have the ability to do so, as described in the E-Sign Act Notice. I understand my electronic signature is valid and enforceable, just like a written signature. The use of an electronic version of this Agreement fully satisfies any requirement that it be provided to me in writing.

2. I agree that I am electronically signing this Independent Representative Application and Agreement (the "Agreement") and that I HAVE READ AND AGREE to be bound by the above Terms and Conditions, and that I HAVE READ AND AGREE to the Policies and Procedures.

3. I understand that I have the right to terminate my Supergized Independent business at any time with or without reason, by sending written notice to Supergized, Inc. Accepted forms of written notification are: email to:

4. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

* I have read and agree to abide by all the above Terms and Conditions, Policies, and Notices.

Payment Information

PayPal payment is required. Your PayPal account will NOT be charged until you complete the sign up process and have agreed to the terms and conditions.

  • Rep Kit - $499.99
  • Web System Activation Fee - $25.00
  • My Wireless Rep : First month included!

* I authorize Supergized, Inc. to charge my PayPal account for my monthly account charges as stated in the Service Agreement Terms and Conditions.