Applicant's Social Security or Tax I.D # ______-______-________
_________________________________________________________________________________
Applicant's First Name / Middle Initial / Last Name (Commissions are
made payable to the name on this line)
_________________________________________________________________________________
Company Name (Use this line only if commission checks are to be made
payable to company name)
_________________________________________________________________________________
Mailing / Shipping Address - Print one address only - use Street Address
or P.O Box
City_________________________State________________
Zip/Postal Code:____________Country________________________
Area Code (_________) Home Phone Number ____________________
Area Code (_________) Work Phone Number ____________________
Area Code (_________) Fax Number________________________
Sponsor's Name: Nattaly Dumais ID Number: 266-329-903
Sponsor's Address: 6611, rue de Meursault CITY: St-Emile
Province: Quebec Zip: G3E-1S2
Country: Canada
Phone:
E-mail: nattypa@yahoo.com
THERE ARE THREE WAYS TO ORDER
1. To become a distributor, simply mail in a cashiers check OR money order for $35.95 plus S&H of $5.95 for a total of $41.90.
2. You can mail in a personal or company check to the address above, for $41.90 plus $3.00 for a total of $44.90. This extra fee is to offset the expense of NSF checks, closed accounts, handling fees, etc. Checks that are not made out to HERBATROL, INC in the correct amount of $44.90 will be returned. This is the only form you will need to become a distributor.
3. You can fax your personal or company check to 817-572-2242. This number is an order line only!!! No more than one bottle of the product can be purchased this way. Multiple purchases must be paid by cashiers check or money order and mailed in to the company. You can also elect to have your product shipped automatically each month about the same time using our auto-ship plan. By indicating your option in the space provided on this form. You must mark the box to receive auto-ship. The price for faxing your order in or auto-ship is the same. The total is $44.90 each time. IF you fax your check, do NOT mail us a copy. Tape your check in this space. Fax this application to the number above. Make sure you fill in the nine digit routing number clearly. These numbers appear on you check, just like the example shown below, in the left hand corner. Place your routing numbers in that space.
DO NOT COVER ROUTING SYMBOLS USE THE BELOW PART WHEN FAXING
Order For Month of _____________________________
Routing Numbers __ __ __ __ __ __ __ __ __
Checking Account Number _______________________________
If choosing auto-draft, specify check draft for ____5th or ____18th
of the month.
Print, complete and mail this form along with a Money Order or Cashiers check for $35.95 plus $5.95 Shipping and Handling for a Total of $41.90 to the address at the bottom of this screen. We strongly suggest that on initial orders you send it to Herbatrol, Inc., via overnight delivery or 2nd day Air to eliminate the delay associated with regular mail.
Herbatrol, Inc.
5849 Okeechobee Blvd, Suite 201,
West Palm Beach, FL 33417
