REPRESENTATIVE APPLICATION AND AGREEMENT
IN CONSIDERATION OF THE MUTUAL PROMISES CONTAINED HEREIN, AMERIPLAN CORPORATION, PLANO, TEXAS (hereinafter referred to as “AmeriPlan”) AND THE PERSON
SIGNING THIS AGREEMENT (hereinafter referred to as “Representative” or “Enrolling Representative” or “Group Representative” or “Association Representative” or “Non-Profit
Representative” and collectively “Representative”) AGREE AS FOLLOWS:
AmeriPlan hereby appoints the Representative and the Representative accepts such appointment under the terms, conditions and covenants stated in this Agreement:
(A) To solicit and procure applications for members in its Dental Benefits Program (“DBP”), as well as its AmeriPlan Health Benefits Program (“AHBP”). However, the
Representative shall not have any exclusive rights therein.
(B) Nothing herein contained in this Agreement shall be construed to create the relationship of employer and employee between AmeriPlan and the Representative. It is the intent
of the parties hereto that the Representative is not an employee of AmeriPlan for any purpose but is an Independent contractor for all purposes. Representative reserves the
right to exercise independent judgment as to time, place and manner of performance under this Agreement. Accordingly, the Representative will not be treated as an employee
of AmeriPlan for Federal or State tax purposes, or for purposes of workers’ compensation or unemployment insurance. The Representative is responsible for payment of all
State, Federal Foreign or local taxes including income tax, withholding tax, social security tax or pension contributions, on funds distributed to Representative from AmeriPlan.
(C) To collect on behalf of AmeriPlan such membership dues and other monies as the Representative may be authorized by AmeriPlan to collect and to conserve the best interest
of AmeriPlan in every way.
The Representative shall endeavor to promote the interest of AmeriPlan as contemplated by this agreement, and shall so conduct itself as not to affe