Broker Enrollment Application

Complete all steps below to join the David Allen Capital network

Enroller Information

Enter the ID of the broker who referred you to DAC

Enroller ID *

Legal name as it appears on your Social Security Card or EIN

First Name *

Last Name *

Company Name (only if enrolling under a company Tax-ID)

SSN / Tax-ID * (U.S. reps required)

Date of Birth *

Format: 05/15/1970 — Must be 18 or older

U.S. Phone Number *

U.S. numbers only — format: (555) 555-5555

Choose A Member Name For Your Replicated Websites *

davidallencapital.com/

Choose a unique name up to 20 characters with no spaces or special characters. This becomes your personal replicated website — write it down!

Your email and password for backoffice access

Email Address *

Confirm Email Address *

Password * (7–20 characters)

Confirm Password *

ⓘ Your password will be used to log into your broker backoffice. Keep it in a safe place.

Your current home or primary mailing address

Country *

Street Address *

Suite / Apt (optional)

City *

State / Province

Non-US/CA? Use the field below

Zip / Postal Code *

Select your enrollment package and review the terms

Complimentary Enrollment $0.00

I confirm that I am 18 years of age or older.

I have read and agree to the Terms & Conditions of David Allen Capital, Inc.

Electronic Signature * Type your full legal name to sign

ⓘ By typing your name above, you are applying an electronic signature to this enrollment application.

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