WELS New Agent Acceptance form

Name*
First Last
In the State/Provence of*
I agree to serve as the registered agent in the state listed above.
- Yes
- No
Name*
Address*
Street Address Address Line 2 City State ZIP Code
E-mail*
Phone*
Data Privacy & Permission*
I AGREE with the terms of the WELS Privacy Policy.
NOTE TO EU CITIZENS, RESIDENTS, TOURISTS, AND OTHER PERSONS TEMPORARILY IN THE EU:

By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy.

WELS Risk Management: [email protected] or 414-256-3260 | Privacy policy
Ref: WELS New Agent Acceptance