NEW DISTRIBUTOR APPLICATION

Name:____________________
SPONSOR ID: Patsy McManus
PHONE :__________________
Address:__________________
City: _______________
State:_________ Zip:________
Shipping Address:  Same Yes or No
Home Phone:
Cell Phone :
FAX NO. :
Country:
Email Address:
Birth Date: Month:___   Day:___   Year:___
Driver License No: State/Country:
__________________________

Credit card number:

__________________________

Exp:  ___/___

Sec. Code: _____

Specify products wanted:

__________________________

 

Print, fill out and email to patsy@robertmcmanus.com. Also, please call to verify that it was received. PH: (985) 320-8403

 

2 Comments

  1. Veronica fernandez
    September 19, 2017

    Leave a Reply

    Iwoluld like to come a distributor

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