CONFIDENTIAL GET ACQUAINTED FORM

If you like what you have read and seen of our Company and are seriously thinking of becoming part of the lucrative Herbal One Distributorship program, we would like to hear from you. Take a minute for us to get acquainted with you by giving a little information on yourself. Please fill in this form and e-mail it to us. We'll get back to you with all of the information necessary for you to make an informed decision to become part of our expansion plans for your area.

Title	Mr.  Mrs.  Ms.
Name	*
Address
Town/City
Province/State
Postal Code/Zip
Day Phone	*
Evening Phone
Best Time to Call?
Email	*
Age Group:
18-25    26-30   31-40    41-50    51-65    65+
Are you currently employed or own a business?
Yes:   No:
If employed, what type of work do you do? How long?
If you are in business, what type of business do you have? How long?
Do you have any knowledge or experience in the any health related fields?
Yes:   No:
If yes, please give a brief description of your knowledge.
Do you have the resources to make an investment of $75,000 to $85,000 for your own Herbal One territory and operating centre?
Yes:   No:
If yes, what area or territory are you interested in:
How soon could you see yourself beginning to take the steps necessary to open one or more centres.
If you have any general comments or specific questions, please indicate them here.
	* Required Fields