Store Onboarding

Store Name

Name

First Last

Email

Phone

Address

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Office Use

Fields for office use only

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Master

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Distributor

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Retailer

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Employee

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Telgoo5 Status

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User Group Type

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Agent Type

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Residual Commission

Enable

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Residual Commission Amount

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Topup Access

Enable

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Topup Commission Amount

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Bill Pay Access

Enable

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Bill Pay Commission Amount

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Recertification Access

Enable

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Recertification Commission Amount

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Intake Commission

Enable

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Intake Commission Amount

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Source

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Agent ID

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Agent Password

Enter Password Confirm Password

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Request Name

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Vendor ID