Step 1
Disclaimer
Step 2
Member Information
Step 3
Upload Documents/Signature
Step 4
Business Information
Step 5
Authorization Agreement
Step 6
Confirm Information
PBA

PLATINUM BUSINESS ALLIANCE
2055 NORTH BROWN ROAD, SUITE 210
LAWRENCEVILLE, GA 30043

404-835-1403
admin@pbaconnect.com
www.pbaconnect.com

Disclaimer

New Member Registration

REQUIRED DOCUMENTATION TO COMPLETE THE APPLICATION

-SALES TAX CERTIFICATE
-VALID COLOR COPY OF THE DRIVERS LICENSE OR STATE ID   
-VALID CURRENT BUSINESS LICENSE OR CURRENT STATE ALCOHOL LICENSE -
-COPY OF THE VOID CHECK FOR ACH OF REBATES
-W-9 FORM   Form W-9 (Rev. October 2018) (irs.gov)

I certify that I am the Primary Owner and I can provide at least one valid form of identification as required to complete my online membership application process.

I certify, and it is my intent, to electronically sign this membership application by electronically submitting it to Platinum Business Alliance. I understand that my electronic submission of this application is the legal equivalent of having placed my handwritten signature on the submitted application and this affirmation.I understand that by electronically signing and submitting this application, I hereby affirm that the statements set forth in the application or otherwise submitted to Platinum Business Alliance in connection with this application are true and correct in every respect.

I understand that providing false or misleading information may disqualify my application. I further agree to cooperate fully with Platinum Business Alliance in the membership application and agree to provide all requested information which relates my Platinum Business Alliance membership application.
 
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