Agreement

Corporate and Associate Agreement

Applicant Information: Please enter all applicable information.
If you are an individual, please skip the Corporation section.

Name:

*First

M.I.

*Last

Mailing Address:
1.
2.
3.
*City:
*State:
*Zip:
-
*Country:

Shipping Address (if different than above):
1.
2.
3.
City:
State/Province:
Zip\Postal Code:
-
Country:
NOTE: Merchandise will not be sent to P.O. boxes!

*Email Address:

Web Address: (www/url)

*Contact's Home Phone:
- - Ext:

*Contact's Office Phone:
- - Ext:

Fax Number:
- -

*Social Security No. (If in the USA):
- -

*Date Of Birth (MM-DD-YYYY):
- -

Partner or Spouse's Name (if interested):

First

M.I.

Last

Corporate or Business Information:

*Corporation or Business Name (if registered):

Federal Tax ID No (or tax exempt number, if available):

*Corporate Contact Name (if different than yourself):

*First

M.I.

*Last

Associate Agreement:1. I have reviewed and understand the benefits of the membership and the marketing plan. 2. I have read the company policies and procedures and been given a copy and agree to abide by them. 3. Under penalties of perjury, I certify that:

Yes No	*(1) the number shown on this form is my correct taxpayer identification number and
Yes No	*(2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.

NOTE: You cannot check Yes on item (2) above if you have been notified by IRS that you are currently subject to backup withholding because of underreporting interest or dividends on your tax return.

Applicant's membership number, if already available:

The following questions MUST be answered or the application will not be accepted:

*2. Have you ever been convicted of a felony?	Yes No
*3. Has anyone who might write business under this Associate Agreement ever been convicted of a felony?	Yes No

If yes, please send documents concerning the charges and dispositions. Having a felony would not preclude your acceptance as an Associate.

Checklist of Initiation Cost and Supplies to market or Products and Services:

1.Associate Agreement Fee	$99.95
2.Distributor Agreement Fee	$299.95
3.Corporate Agreement Fee	$599.95
*Credit Card Number:
*Card Type:	MasterCard Visa Discover American Express
*Credit Card expiration date (MM/YYYY):	-
*Mother's Maiden Name: (For security purposes.)

Pay by Check?

*Pay by Direct Deposit Fee $15.00 for Associates, $25 for all others)	Yes No
Financial Institution Name:
Account No: Routing No:

Checking	Savings