Independent Representative Application

Home Telephone Number	Social Security #
Request Password
Business Telephone Number
Last Name
First Name	County
Business Name	Live in City Limits Yes No
Mailing Address (this will be your shipping address for all correspondence, kits and materials. P.O. Boxes cannot be used)
City
State Alabama Alaska Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code

Please read and check the following boxes.

AGREE	I understand that I may enroll as an Independent Representative in Essence of Eden's Management Services Program for $179.00 with an annual renewal of services at $150.00. This program includes the Retail Products Package the Essence of Eden's Representative Training Program. I will receive down line reports and the company newsletter (available online, mailed only upon request) for the entire year. I UNDERSTAND THAT MY PURCHASE OF THE MANAGEMENT SERVICES PROGRAM IS REFUNDABLE PER THE TERMS DESRCIBED IN THE REPRESENTATIVE TERMS AS SHOWN ON THE BACK OF THIS FORM. I hereby apply to become an Independent Representative for Essence of Eden; I have read carefully and agree to be bound by all provisions of the Terms and Conditions which are printed on this application and all published Policies and Procedures of Essence of Eden.. I understand that purchase of the Management Services Program is refundable and that becoming an Essence of Eden customer is not required to participate as an Independent Representative.
AGREE	You have read and agree to this document.

I wish to purchase

	Management Services Program at $175.00
	You will receive the benefits of a full service program! You will receive your web site free (if you maintain your monthly sales goal of $200), 50 business cards, catalogs, country bunny tote bag and a product package valued at over $60 complete with our best selling signature items to start your bath and body business off right. Corporate support services, monthly down-line reports to track all of your representative's activities, commission reports, business presentation booklet, as well as discounts at convention.