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

 

Be the first to comment.

Leave a Reply


*