SMART Provider Account Form

SMART Provider Account Form
Are you opening a new account?*

YesNo
SMART Account Number*
Account Name*
Account Type*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I/we would like to:*

Open a New Account
Account Name*
Account Type*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary User Name (Must be a Registered Volunteer)*

First NameLast Name
Primary User ID #*
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Primary User Signature*

Clear
Primary User Email*
example@example.com
Additional User Name (Must be a Registered Volunteer)

First NameLast Name
Additional User ID #
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Additional User Signature

Clear
Additional User Email
example@example.com
Additional User #2 Name (Must be a Registered Volunteer)

First NameLast Name
Additional User #2 ID #
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Additional User #2 Signature

Clear
Additional User #2 Email
example@example.com
Additional User #3 Name (Must be a Registered Volunteer)

First NameLast Name
Additional User #3 ID #
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Additional User #3 Signature

Clear
Additional User #3 Email
example@example.com

Add User(s)
Additional User #1 Name (Must be a Registered Volunteer)*

First NameLast Name
Will this person be the Primary Account Holder?*
Additional User #1 ID#*
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Additional User #1 Signature*

Clear
Additional User #1 Email*
example@example.com
Additional User #2 Name (Must be a Registered Volunteer)

First NameLast Name
Additional User #2 ID#
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Additional User #2 Signature

Clear
Additional User#2 Email
example@example.com
Additional User #3 Name (Must be a Registered Volunteer)

First NameLast Name
Additional User #3 ID#
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Additional User #3 Signature

Clear
Additional User #3 Email
example@example.com
Additional User #4 Name (Must be a Registered Volunteer)

First NameLast Name
Additional User #4 ID#
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Additional User #4 Signature

Clear
Additional User #4 Email
example@example.com

Remove User(s)

If you are removing the Primary Account Holder, please be sure to note who the new Primary User should be on the "Authorized Signature" page under the "Comments" section. If the new Primary User is not already on the account, be sure to add them using the "Make additional changes" option on the next page and then select "Add Users".
Remove User #1 Name*

First NameLast Name
Remove User #1 ID Number*
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Remove User #2 Name

First NameLast Name
Remove User #2 ID number
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Remove User #3 Name

First NameLast Name
Remove User #3 ID number
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Remove User #4 Name

First NameLast Name
Remove User #4 ID number
Prefix (numbers before the dash)
Suffix (numbers after the dash)

Change Account Name
I am authorizing SMART to change my account name to:*

Transfer Unassigned Funds to Another Provider Account

If you are wanting to transfer all of the funds and/or close the account, please go back and select "merge" instead of "transfer".
Transfer Amount*
The amount you would like to transfer
I want the funds transferred from my:*
If transferring from both options above, you will need to submit two separate requests.
NOTE: SMART deposited unassigned funds will keep their original expiration date when transferred.
Transfer from:*
Your SMART account name
Your SMART account number
Transfer to:*
Their SMART account name
Their SMART account number
Was this transfer of funds Board approved?*
All funds transferred from an association account require Board approval.

Merge Accounts
Merge this account:*
Account Name (this is the account going away)
Account Number
Into:*
Account Name (this is the account that will remain)
Account number

Would you like to make additional changes?*

YesNo, I am finished.

Please choose your additional changes*

Authorized signature for requested changes
Your Name*

First NameLast Name
Your USBC Member ID #*
Prefix (numbers before the dash)
Suffix (numbers after the dash)
Your Email*
example@example.com
Date*

MonthDayYear
Date
Your signature and use of SMART constitutes acceptance of SMART Terms & Conditions (please see the next page for details)*

Clear
Additional Details/Comments:
Please use this section if there is any additional information you think we need to know regarding the requested changes.

The Agreement between SMART and a Provider is the complete Agreement of the parties in accordance with the internal laws of the State of Texas. Any dispute or arbitration arising from or relating to this Agreement must be resolved in Arlington, Texas, as the exclusive venue.

SMART Account

Upon receipt of a SMART Account you are agreeing to:
• Participate in the SMART scholarship program
• Transfer scholarship funds to SMART within 30 days of the end of the league/tournament or award date if meritorious honor.
• Read and accept the terms and conditions of the SMART Policy Manual, which is available online at www.BOWL.com/smart.
• Hold SMART harmless and indemnify SMART from and against any and all claims, causes of action, damages, loss, penalty, judgments, costs and expenses (including attorney fees) arising from, related to or in connection with, any acts or failures to act by the Provider, its employees, invitees, officers, directors, agents
and representatives, including but not limited to actions or omissions relating to or in connection with any activities conducted by the Provider through which the Provider collected funds, of the handling or accounting for any such collected funds.

SMART will acknowledge your submission via email.
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