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Club-ABLE welcomes your decision to join us as a Preferred Provider.

Please complete this one page document you will received document by email.
Please sign up and return to us at the enable@club-ABLE.com.

Part A: Contact Information:

Part B: Statement of Agreement:

I hereby certify that I am currently Licensed to Practice in the State of California as per the above designation(s). I am the Owner/ Manager of the business named above.
My business has the necessary licenses and permits to carry out the business and to supply the services and products as stated. I agree to offer a ____ % fee discount for my services / products from my regular fair market pricing to the physically disabled community members of Club-ABLE. I understand that Club-ABLE members will show me their Club-ABLE ID and then settle their accounts directly with me. It is my responsibility to determine how and under what fee terms I am willing to offer my services / products provided that I offer at least a 10% discount to members of Club-ABLE.
This Statement of Agreement will be posted on the Club-ABLE website so that members may determine if they are interested in my services / products.