Sales Department New Hire Enrollment

Basic Info

Basic Info
First Name *
Last Name *
Email *
Office Location *
Address *
City *
State *
Zip *
Profile Image- Attach a front facing high resolution image with a white or neutral background *
Phone *
Date of Birth *

Harness 2021 Rep Agreement

Harness 2021 Rep Agreement

W9

Identification Proof

*Please provide two (2) valid forms of identification to complete your W9.
Identification #1 *
Identification Option #1 Uploaded: *
Identification #2 (must be different than ID #1) *
Identification Option #2 Uploaded: *

Bank Wire Instructions (ACH)

Bank Wire Instructions (ACH)
Business or Personal Name on Bank Account *
Bank Address *
Bank Account Type *
ACH Routing Number *
Account Number *
Wire Transfer Routing Number (different than direct deposit info)
Voided Check Image (Optional)

CSLB HIS License (CA REPS ONLY)

Please identify and upload any existing or current licenses that you may have.
CSLB HIS License (CA REPS ONLY)
Expiration Date
License 1 Upload
NOTE: Acceptable file formats: JPEG/PNG/PDF, Recommended file size is below 20 MB

HARNESS Marketing + Media Consent Form

Consent Form

HARNESS Liability Waiver

HARNESS Liability Waiver

Escrow Account

Escrow Account

Apparel Questionnaire

Apparel Questions
Shirt Size *
Jacket Size *
Hat Size *
Shoe Size *
Waist Size *
Pant/Short Size *