Member-Distributor Signup:

Personal Information

This signup form is encrypted for your protection. All sensitive information will remain secure over the Internet. Please note that a business entity will not be able to enroll over the Internet. Click here for a business entity application form.

Personal Sponsor:    
Last Name:
ID Number:
 
Applicant's Name:*
First Name:
 M/l:
 Last:
Applicant ID:*
Social Security Number

Number:
 
 
Spouse (or Co-Applicant's Name)
First Name:
 M/l:
 Last:
Co-Applicant ID:
Social Security Number

Number:
 
 
Mailing Address:*
City:*
State/Province:*
 Zip/Postal Code:*
-
     
Click here to make the shipping address the same as the mailing address
Shipping Address:* Note: UPS will not deliver to PO Box numbers
City:*
State/Province:*
Zip/Postal Code:*
-
   
Date of Birth:*
Month: Date: Year:
 
E-mail address:
 
*Your Daytime Phone:
Area Code:    Number:
*Your Evening Phone:
Area Code:    Number:
Alternate Phone:
Area Code:    Number:
Cellular Phone:
Area Code:    Number:
 
Your FAX Number:
Area Code:    Number:
* Items marked with stars are required fields.
 

INSTRUCTIONS

Personal Sponsor: enter the last name and ICS ID number of your personal sponsor.

The S.S./Federal ID # is absolutely required and must be the number corresponding to the distributorship.

Having a co-applicant is optional. It is highly recommended that the spouse information be filled out as the spouse is considered having a beneficial interest in the distributorship.

Shipping address: we must have a second address for shipping if your mailing address is a PO Box, or if you would like your AutoShip sent to an alternate address.

Birthday: This is needed as verification that the new distributor is of legal age to be a distributor in the state of their residency.

Phone number: Please indicate the numbers where you may be reached.