Agency Appointment !

Thank you for taking the next steps in getting your agency appointed and approved to offer and distribute online risk management and compliance tools to your customers.
Once your agency is approved, the person you assigned as the agency admin will receive an email with login instructions and the executed agreement.
Please complete the following steps.

Agency Appointment Process:

STEP 1 Download [Agency Agreement] here. Review, complete and sign.
STEP 2 Upload completed [Agency Agreement] here or email to service@mindmeldlearning.com
STEP 3 Complete all agency information. (located to the right)
STEP 4 Upload your [Agency logo] here. (optional)
STEP 5 Click submit

If you have any questions about the agreement, commissions or the sales process, please contact Michael Aberle at service@mindmeldlearning.com or 800-861-7642

Agency Application | Information

Admin First Name *

Admin Last Name *

Admin Email *

Admin Phone

Accounting First Name

Accounting Last Name

Accounting Email

Payment Collection Info

MindMeld will bill your customers directly. (Net 30 billing available upon request and approval).

Agency Name *

Mailing Address Street

Mailing Address City

Mailing Address State

Mailing Address ZipCode

Is physical address same as mailing address?

Physical Address Street

Physical Address City

Physical Address State

Physical Address ZipCode