Good Ground Holdings, LLC
P.O. Box 974
Central Arkansas 72203
  

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CASH REWARD PROGRAM REGISTRATION FORM

Name: Home Phone: (     )
Mailing Address: Work Phone: (     )
City:                            State:            Zip: Cell / Pager: (     )
Social Security #: Email Address:

ACKNOWLEDGEMENTS

I hereby acknowledge and agree that:

  1. I am not an employee of Good Ground Holdings, LLC
  2. I am responsible for any income tax liability and for notifying the IRS of my earnings
  3. If I earn $600 or more during any calendar year, Good Ground Holdings, LLC will issue a 1099 IRS Form for tax purposes as required by law.
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Date

Fax to or mail to
Good Ground Holdings, LLC
P.O. Box 974
Central Arkansas 72203