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HERBATROL, Inc. International Associate Agreement
5849 OKEECHOBEE BLVD. Suite 201
West Palm Beach, FL 33417, USA
(561) 478-5913
You must fill this application out neatly and clearly or we cannot process your order .

APPLICANT INFORMATION - PRINT CLEARLY - USE BLACK INK

Applicant's Social Security or Tax I.D #  ( you can use your phone number ) ______-______-________

_________________________________________________________________________________
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/Province________________

Zip/Postal Code:____________Country______________________________

Area Code (_________) Home Phone Number ____________________

Area Code (_________) Work Phone Number ____________________

Area Code (_________) Fax Number_____________________________

SPONSORSHIP INFORMATION

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

You Must Check The Appropriate Lines

_____NEW ORDER _____REORDER

To become a distributor, simply complete and mail this form along with a Money Order or Cashiers check for $35.95 plus $8.95 Shipping and Handling for a Total of $44.90 US to the address below. 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, USA


Commission checks are paid on the 10th of each month,
FAX ON DEMAND: 415-273-6096