MEMBERSHIP
TRANSFER FORM
DAXEN, INC.
565 Brea Canyon Road, Ste.
B • Walnut, CA 91789
OFF (909) 348-0188• FAX (909) 348-0189
www.
dxnusa.
com
1.
APPLICANT’S INFORMATION DISTRIBUTOR ID NUMBER
818032888
NAME (FIRST, MIDDLE, LAST) OR NAME OF BUSINESS ENTITY...
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MEMBERSHIP
TRANSFER FORM
DAXEN, INC.
565 Brea Canyon Road, Ste.
B • Walnut, CA 91789
OFF (909) 348-0188• FAX (909) 348-0189
www.
dxnusa.
com
1.
APPLICANT’S INFORMATION DISTRIBUTOR ID NUMBER
818032888
NAME (FIRST, MIDDLE, LAST) OR NAME OF BUSINESS ENTITY
SOCIAL SECURITY NUMBER OR BUSINESS ENTITY ID No.
(THIS INFORMATION IS REQUIRED TO QUALIFY AS A DISTRIBUTOR)
DATE OF BIRTH
(MM/DD/YY)
MAILING ADDRESS
CITY STATE ZIP/POSTAL CODE COUNTRY
PHONE NUMBER FAX NUMBER
CELLPHONE / BUSINESS E-MAIL
2.
SPONSOR / PLACEMENT INFORMATION
SPONSOR ID NUMBER SPONSOR PHONE NUMBER
SPONSOR NAME (LAST, FIRST, MIDDLE)
3.
AGREEMENT
This Agreement is entered into between the APPLICANT, named above (hereafter “APPLICANT”) and DAXEN, INC.
The parties agree:
APPLICANT hereby applies as a DXN DISTRIBUTOR (Independent Distributor) in DAXEN INC.
APPLICANT is authorized as a DXN
DISTRIBUTOR (Independent Distributor) and granted the rights to sell DAXEN INC.
products.
DAXEN INC.
reserves the right to accept
or
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