1501 E. Centre St. #209 
Rapid City, SD 57703-3004		 THE HEALTH NUTS
APPLICATION TYPE: 
   NEW 
   UPDATE
605-341-4056 Office 
605-341-4192 Fax 
1-888-383-4056
Associate Application and Agreement
New Member SS # or Fed ID # THN # 
(office use)
Sponsor Name: Patricia Krenik
SS # or FID # or THN #  921 Sponsor's Phone #  360-482-4287
Check one:  Individual  dba  Corporation 
Trust  Other 		 Call your Sponsor if you need assistance!
Applicant's Name (Last, First, Middle Initial) Date of Application
Street Address PO Box #
Date of Birth
City State Zip Code
Home Phone Fax Phone Work Phone E-Mail Address
 
Please select ONE of the following options, and consult your sponsor for assistance to be sure you understand your choices:
OPTION 1: Auto-Purchase and Auto-Payment
Please deduct my purchases from my commission check for Auto ship. I instruct and authorize The Health Nuts to deduct from my commissions my future product purchases as I earn enough commissions to make these purchases for Qualification:
In the event my commission check will not purchase my qualifying order for the following month please:

one		 Charge my credit card to purchase products for the next month or;
Draft my bank account to purchase products for the next month.
Completed STANDING ORDER must be submitted with this application!
OR
OPTION 2: Manual Purchase 
I understand I will be responsible for ordering and paying for all my products each month. I understand I will not receive a commission check if I fail to make my monthly qualifying purchase.
 
Applicant signature (required)
Date
*ANY CHANGES MUST BE DONE IN WRITING WITH THIS FORM. 
I hereby apply to become an independent representative of The Health Nuts. I have read and understand the Policies and Procedures. I have read and understand the compensation plan.
For Office Use Only
$ Rec'd 
Date Rec'd 
Order # 
By signing below, I certify that I am of legal age in the state I reside. I understand I have the right to terminate, with or without reason, by submitting written notice to The Health Nut's home office. Becoming an independent representative is automatic pursuant to my purchase of products payable by money order, chashier's check, credit card or bank draft.

Applicant signature (required)
Date
This form must be filled out, signed and mailed to the home office!


 
The Health Nuts 

1501 E. Centre Street #209 
Rapid City, SD 57703-3007
1(605) 341-4056 Office
1-888-383-4056 Toll Free
1(605) 341-4192 Fax