(Please fax completed form to: ___________)
Business company name ______________________________________________
Federal ID number ________________________________
Mailing Address:
______________________________________________
______________________________________________
______________________________________________
Street, City, State, Country, Zip/Postal Code
Telephone (required)______________________________________________
Fax # ______________________________________________
Please fill in the following sections with the personal information of all persons
having a beneficial interest in this company (i. e., president, vice president,
secretary, and board of directors or shareholders). You may use as many addendums
as necessary.
Name _____________________________Social security number_____________________
Phone _____________________Fax _____________________E-mail ___________________
Position/ title in company___________________________
Signature _______________________________Date _____________________________
Name _____________________________Social security number_____________________
Phone _____________________Fax _____________________E-mail ___________________
Position/ title in company___________________________
Signature _______________________________Date _____________________________
Name _____________________________Social security number_____________________
Phone _____________________Fax _____________________E-mail ___________________
Position/ title in company___________________________
Signature _______________________________Date _____________________________
To sign up a company as an ICS Member-distributor, the following documents
will be necessary:
1. Member-distributor Agreement (with the company name listed as the Member-distributor
name).
2. Business Application Addendum.
3. Copy of the Federal ID certificate.
4. Copy of the articles of incorporation (or other legal documents).
Member-distributor name__________________ (required)
ICS ID# _________________________(required)