Sales Representative Signup Form


The Grapefruit Magic Diet

We pay our Affiliates in the U.S.A., and Worldwide via U.S. Bank Check, Cash and Direct Deposit.  Cash and Direct Deposit is paid via Western Union (in all countries worldwide), and U.S. Bank Check is mailed worldwide via U.S. Postal Mail.


Enter your payment mailing address

(Please make sure this is correct.)

First Name:

 

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Middle Name:

Last Name:

 

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Suffix:

Address:

 

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City:

 

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State:

 

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Providence:

Zipcode:

 

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Country:

 

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Payable to Name:

 

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(You will need a Drivers License or Government Photo ID with this name on it if picking up cash, or withdrawing funds from your bank.)

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 with your head and face clearly visible.  Thank you.)

Affiliate Bio:

 

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(Affiliate Bio will be streamed to media outlets in the future to showcase our successfull affiliates.)

E-Mail Address:

 

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Payment Method

 

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Cash will be sent to your nearest Western Union payment location based on the city and country specified in your payment address above.   You can find your Western Union payment location here.   U.S. Bank Check is sent directly to your address specified in payment address above, if selected.

E-Mail Notification:

Commission

Referral Bonus

Residual Commission

Payment

Website:

Password:

 

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I agree to the Sales Representative Agreement.

Enter Verification Code:

 

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