Sales Representative Signup Form


The Grapefruit Magic Diet

Payments in U.S.A. and Worldwide


Please enter your mailing address

First Name:

 

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Middle Name:

Last Name:

 

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Suffix:

Address:

 

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City:

State:

Providence:

Zipcode:

Country:

 

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Payable to Name:

 

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(You should have a valid government issued id with this name on it.)

Affiliate Photo:

 

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(For Sales Rep of the Month.  Photo will be displayed on corporate webpage, in the affiliate program, and also on several other news and media outlets in the future.  Please upload a photo of yourself.)

Affiliate Biography:

 

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(Affiliate Biography will be streamed to media outlets in the future to showcase our successfull affiliates.  Max characters 1,500)

E-Mail Address:

 

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(We don't send spam.)

Payment Method

 

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Send E-Mail Notifications:

 

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Commission

 

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Referral Bonus

 

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Residual Commission

 

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Payment

 

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Send Affiliate Starter Pack to Mailing Address:

 

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Send the Affiliate Starter Pack with (4) Automobile Advertisements, (2) Work From Home Bullitan Board Advertisements and (27) Business Cards Pre-Cut and Pre-Printed with my Name and Affiliate ID to my mailing address, (once on signup)(Free.).

Your Website:

Password:

 

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I agree to the Sales Representative Agreement.


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