Genie CashBox Merchant Membership Form

Activation Fee

Charges on   Activation Fee (One time): $49.95     
permanent   Monthly Fee: $19.95     
activation:   Pre Paid Calling Time: $0.00    $49.95 USD (NO Sales Tax)
Personal Information -  Please complete the form below

Referral Genie No.:  (855) 613-6614   Pro Internet Marketer
First Name:  (Required)
Middle Name: 
Last Name:  (Required)
Business Name: 
Genie Gateway Name: 
Web Site: 
Street Address:  (Required)
Apt# / Suite#: 
City:  (Required)
State:  (Required)
Country I reside in:  (Required)
ZIP Code:  (Required)
Cell Phone No.:  (Required)

Your Genie CashBox Merchant Account's "One Time Activation Code" will be sent as a text message to the cell phone number you provided. Please verify that the cell number you provided is correct. Otherwise, you will not be able to activate your Genie CashBox Merchant Account.

Work Phone No.: 
Home Phone No.: 
Email Address:  (Required)
Confirm Email Address:  (Required)

Your Genie CashBox Merchant temporary passcode will be emailed to this address, please verify that you provided the correct email address, otherwise, you will not be able to access your Genie CashBox Merchant account.

Pay By Credit Card

Payment Type: (Required)
Card Name: (Required)
Credit Card No.: (Required)
Use above address
Address: (Required)
ZIP Code: (Required)
Expiration Month: (Required)
Expiration Year: (Required)
Security Code: (Required) What is it?

Please review our Terms and Conditions below

I have read and agree to all the terms and conditions above

Please review all the information above before pressing the Continue button!