Enchanted Potions

Independent Distributor Application

PLEASE NOTE: Enchanted Potions requires a minimum $10 purchase to be made at the time you submit your application. The final page of our online application contains a link which will take you to our Kit purchase page. Applications received without the required purchase will not be processed and will be deleted from our system! Please be sure to make your purchase so that you may enjoy all the benefits of being a part of our growing family of Distributors. Thank you!

STEP 1 OF 3

Name: *
Address: *
City: *
State: *
Zip: *
E-mail: *
Phone: *
When is the best time to contact you?
Morning
Afternoon
 Evening
What is the best means to contact you?
Phone
E-mail
Birth Date: *
Website:
Sponsor:
   
If you have no sponsor, how did you hear about Enchanted Potions?
   
I have read and agree to the Terms & Conditions *
   
Social Security Number - To be submitted via a completed and signed W-9 form, printed and sent by mail to the home office. I understand that I must make a $10 minimum purchase immediately after submitting my application and that my W-9 form must be sent to the home office within 7 days in order to activate my membership. *
       
Electronic Signature: *

Date: *   

* Required