PERSONAL INFORMATION:

Full Name

(*)

Street Address 1

Street Address 2

Zip Code

E-Mail

Home Phone

Work Phone

Date of Birth

Social Security #

(*)

Drivers License #

(*)

State Issued

Nearest Relative (not living with you)

Name

Address

City

State

Zip

Phone

CREDIT CARD REFERENCE:

Account #

Exp. Date

Cardholder Name

security code

PROFESSIONAL REFERENCES: (need 3)

Contact Person

Phone

Contact Person

Phone

Contact Person

Phone

PERSONAL REFERENCES: (need 2)

Address

Years Known

Address

Years Known

I certify that the above statements are true and complete to the best of my knowledge. I understand and acknowledge that I am an independent distributor of THE PLEASURE COMPANY INC. and will attend all training workshops and/or classes In order to qualify for my distributorship.  I understand that upon completion of the requirements set forth of a Qualified Distributor of THE PLEASURE COMPANY INC. that the basic Starter Kit will become solely my possession and not before then. I understand I will collect and forward any and all sales taxes to every state in which I distribute products. I agree to protect the name, image, and reputation of THE PLEASURE COMPANY INC., and distribute only those products purchased from THE PLEASURE COMPANY INC. I agree to forward paid orders to THE PLEASURE COMPANY INC. within 48 hours of the sale, in order to insure prompt delivery for my customers. During the term of my distributorship, and for three (3) years after such distributorship concludes, I agree not to use any information or trade secrets for any purposes whatsoever, or divulge such information to any person(s) other than persons THE PLEASURE COMPANY INC. has given written consent, unless compelled to by governmental or judicial order. I also understand that violation of this contract will result in immediate cancellation of my distributorship.”

Phone #

Resale #