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APPLICATION DISTRIBUTOR OPPORTUNITY
VITALITY-LIFECHOICE, Inc. POB 21133 Carson City, NV 98721 Phone: 800-423-8365(out of
state)
PLEASE PRINT OR TYPE THE FOLLOWING:
Social Security Number____________________ or Fed. ID#______________________
Distributor name (your name or your company's name):
_________________________________________________________
Your name (if different from that above)
________________________________________ Birthdate_________
Spouses name (if applying)
______________________________________________ Birthdate__________
Street address and any apartment number:
______________________________________________
City, State, Zip______________________________________
Resale tax ID if any: ___________________
Residence phone_(____)__________ Business phone_(___)______
SPONSOR INFORMATION:
Name: Pat Krenik ID#20986 (360) 482-4287
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To VITALITY-LIFECHOICE: I/we hereby apply for appointment as a Distributor of your
corporation. I understand that a Distributor is not any employee, legal representative, or
agent of Vitality-LifeChoice, Inc., hereinafter known as the Company. A Distributor will
operate his/her own business, will buy Company products for cash; will promote the sales
and agree to comply in accordance with the Company marketing plan, literature, and
amendments thereto. This Distributorship may be revoked by the Company if Distributor
fails to comply with terms of the agreement. I/we understand that no purchase of product
is required to become a Distribuor of the Company.
I undertand that if the Company has not received their copy of this application, no
purchase volume credit can be given on my purchases.
Signature:___________________________ Spouse (if applicable)______________
Date_______________________