Sunday, May 20, 2012
Account Management
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Join the Program!
Click here to become a cardholder, an advertising agent, franchise owner, or a participating merchant.
Enroll Advertising Agent

Complete this form and click submit to enroll a new Advertising Agent in the MyChoice program. Upon submitting this application, Agent agrees to pay a $149.95 setup fee to sell MyChoice products or services. Agent understands that the setup fee includes the agent kit, the IPTV Set Top Box and a MyChoice Consumer Card valid for two years.

Applicant Information
Last Name  
First Name  
Middle Initial  
Business Name  
Tax Id Type  
Social Security Number  
Birthdate  
Street Address 1  
Street Address 2  
Country  
select
Zip  
City  
State  
select
County  
Mailing Street Address 1  
Mailing Street Address 2  
Mailing Country  
select
Mailing Zip  
Mailing City  
Mailing State  
select
Mailing County  
Business Phone Number  
Fax Phone Number  
Mobile Phone Number  
Home Phone Number  
Email Address  

Method of Payment
Payment Method  
select

Sponsoring Agent
Sponsor Id  

Terms and Conditions

Finish Enrollment

Once you have reviewed the information above and are satisfied that it is correct, click the Process Enrollment button to complete the process.

This process could take a few moments to complete. Do not click the Process Enrollment button more than once or you could potentially be double charged.