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Topics: Independent contractor, National identification number, Taxation in the United States Pages: 14 (3585 words) Published: June 27, 2013
INDEPENDENT DISTRIBUTOR APPLICATION

USA Fax 800.466.6289 Primary Applicant Contact Information

Primary Applicant *Required Information
(Please Print Clearly)

( (

) )

-

(

)

-

*First and Last Name (Legal Name)

*Home Phone

Cell Phone

Co-Applicant or Company Name

Fax Number

-

-

*Applicant E-mail

*Birth Date (MM/DD/YYYY) (Applicant must be 18 years or older)

*Social Security Number or EIN for Business Entity

Primary Applicant Billing Address
(Must match your credit card address)

Primary Applicant Shipping Address
(Leave blank if same as billing address)

*Address

*Address

*City

*State

*Zip Code

*City

*State

*Zip Code

I am upgrading my Preferred Customer account to a Distributor account. I understand my Enroller and Placement Sponsor will not change.

Preferred Customer ID

Enroller Information

Placement Sponsor Information

(Your enroller is the individual who introduced you to LifeVantage.)

(Your placement indicates the individual under whom you are placed. If no one is listed, your enroller also becomes your Placement Sponsor. Your enroller is able to place you within 30 days.)

Enroller Name

ID Number

Placement Sponsor Name

ID Number

LifeVantage Independent Distributor Enrollment Order

All new distributors are required to purchase a Start Kit at the time of sign-up. The cost of the Start Kit is $50 plus applicable shipping, handling and sales tax. Prices do not include shipping, handling or sales tax. The distributor can meet the Start Kit requirement either by purchasing the kit by itself or as a component of the optional upgraded business builder kits shown below: Start Kit, 6 Protandim® Bottles, 1 (10-pack) Protandim® Samples, 2 LifeVantage TrueScience® 50ml Bottles, 2 (10-pack) LifeVantage TrueScience® Samples, 3 LifeVantage® Canine Health Bottles, 1 (30-pack) Presentation Tear Off Pad, 1 (25-pack) Newspapers, 1 (10-pack) LifeVantage® Opportunity DVDs, 1 LifeVantage® Decal and 2 disc set Pro Audio series plus an additional four weeks of discs.**

Vantage Pack 1 - $630.00 (400 PV, $545 Product Value, $135 Infinite Fast Start Bonus)

Vantage Pack 2 - $630.00 (400 PV, $520 Product Value, $135 Infinite Fast Start Bonus)

Start Kit, 13 Protandim® Bottles, 1 (30-pack) Presentation Tear Off Pad, 1 (25-pack) Newspapers, 1 (10-pack) LifeVantage® Opportunity DVDs, 1 LifeVantage® Decal and 2 disc set Pro Audio series plus an additional four weeks of discs.** Start Kit, 12 Protandim® Bottles, 1 LifeVantage TrueScience® 50ml Bottle, 1 (30-pack) Presentation Tear Off Pad, 1 (25-pack) Newspapers, 1 (10-pack) LifeVantage® Opportunity DVDs, 1 LifeVantage® Decal and 2 disc set Pro Audio Series plus an additional four weeks of discs.**

Vantage Pack 3 - $630.00 (400 PV, $550 Product Value, $135 Infinite Fast Start Bonus)

Vantage Pack 4 - $630.00 (400 PV, $545 Product Value, $135 Infinite Fast Start Bonus)

Start Kit, 10 Protandim® Bottles, 1 LifeVantage TrueScience® 50ml Bottle, 3 LifeVantage® Canine Health Bottles, 1 (30-pack) Presentation Tear Off Pad, 1 (25-pack) Newspapers, 1 (10-pack) LifeVantage® Opportunity DVDs, 1 LifeVantage® Decal and 2 disc set Pro Audio series plus an additional four weeks of discs.** **Pro Audio Series Enrollment The purchase of a Vantage Pack includes 4 presentations from LifeVantage leaders (on 2 CDs) and 4 weeks enrollment (1 CD weekly for 4 weeks) in the Pro Audio Series program. You will then be charged $3.00 weekly, plus sales tax, to remain enrolled in the program. Opt OUT of enrollment of Pro Audio Series ©2013 LifeVantage Corporation • 9815 S. Monroe St., Ste. 100, Sandy, UT, 84070 • 866.460.7241 • lifevantage.com This form may not be altered without the express written consent of LifeVantage. 13020601.07 CMP-US-FRM200-02 PAGE 1 OF 4 Revised 03/2013

INDEPENDENT DISTRIBUTOR APPLICATION

USA Fax 800.466.6289

Start Kit - $50 (0 PV)
7

Note: When ordering a Start...
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