Name ____________________________________________________________________
ICS ID# _______________________________________
Address ________________________________________
City __________________________ State ____________________ Zip ___________________

Telephone number ________________________________ Fax ______________________
SS# _______________________________

I request reinstatement of my Member-distributor status with ICS from Class C to Active Member-distributor. I understand in order to maintain my Member-distributor status I need to:
1. be a participant in the Monthly AutoShip Program, OR
2. every 60 days purchase at least $48 of ICS product AND sponsor a new Member-distributor

I also understand I will be eligible to receive earned bonuses in ICS's compensation plan immediately if I am on the Monthly Autoship Program. If I am not on the Monthly Autoship Program, commissions will be earned only after I have purchased $48 of ICS product AND I have sponsored a new Member-distributor, and that if I fail to do so within 60 days from this request for reinstatement, my status will revert to Class C status.

Signed __________________________

Date ____________________________

Coapplicant ____________________

Date___________________________

Reinstatement Fee = US $10

Payment by Automatic checking Account withdrawal
(Must attach a voided check & an ACH Authorization Form)
Payment by Credit card
Card type: VISA MasterCard

Name (as it appears on card) ____________________________________________________
Credit card number __________________________________ Exp. date __________
Credit card billing address ______________________________________
Billing zip___________

Signature _______________________Date ____________________