Cdvbn
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
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