Individual Signing Up for the Claims Agent Referral Program*

Certified VA/OGC Claims Agent

Certified VA/OGC Claims Agent (Lawyer)

Program Partner (Referrals only)

Agent's First Name*

Agent's Middle Name

Agent's Last Name*

Agent's Phone Number

Agent's Email*

Your Message

By signing my name below, I agree with the general terms of the Claims Agent/Program Partner Referral Program (as outlined on the previous page "How our Referral Program works for Cert Claims Agents/Program Partners". I understand I am not an employee of Veteran Appeal Center (Automate Analytics, Inc) and that I am signing up to give and/or receive referrals. I promise in good faith to pay the proper referral fee if I receive a referral and have a successful appeal. I also understand I will receive a referral fee if I refer, and there is a successful Appeal by Veteran Appeals Center.*

VA Claims Agent/Partner Referral Program Signup

Veteran Appeals Center

+1 (910) 548-4118 Call 24-7

AppealsOffice@veteranappealscenter.com

veteranappealscenter.com

Billy Jackson, USMC 2001-2009, BA Political Science, MBA, LSSBB

U.S. Dept of Veteran Affairs/OGC Accredited Claims Agent, Pendleton, IN

Researchable at va.gov/ogc/apps/accreditation/