880 Corporate Drive, Suite 200, Lexington, Ky 40503

Independent Representative (IR) Application & Agreement

1. APPLICATION INFORMATION

Last Name First Name Ml Home Telephone Number

Mailing Address PO Box cannot be used (This will be your shipping address for all correspondence and kits.) Business Telephone Number

City State Zip Fax Number

E-mail Address Date of Birth: MM/DD/YY State of DL Issuance

Driver’s License Number

2. APPLICATION FORTUNE ID #
THE FOLLOWING NUMBER WILL SERVE AS YOUR FORTUNE IDENTIFICATION NUMBER UNTIL THIS APPLICATION HAS BEEN PROCESSED AT
WHICH TIME IT IS YOUR RESPONSIBILITY TO CALL FORTUNE REPRESENTATIVE SERVICES TO OBTAIN YOUR NEW IDENTIFICATION NUMBER.
Fill in your SOCIAL SECURITY NUMBER.

3. SPECIAL SERVICES PROGRAM

I elect to enroll in FHTM’s Optional Special Services Program, therefore please waive the refundable $75.00 deposit. I understand that this program includes consul-
tancy advice provided by the Representative Support Call Center to assist in building my business. In addition, I will receive e/downline reports and the company e/
newsletter for one year. Training is available at the FHTM home office, and by approved trainers regionally. I understand that it is my responsibility to complete all train-
ing requirements. Training is of 2-3 hours duration regarding FHTM services, IR procedures and techniques and is conducted by trainers certified and paid by FHTM.
I UNDERSTAND MY PURCHASE OF OPTIONAL SERVICES IS NON-REFUNDABLE UNDER ANY CIRCUMSTANCES AFTER 10 DAYS
INITIALS
FROM THE DATE OF THIS AGREEMENT.
$199.99 Special Service Package includes access to all reports and sales literature.
Personal Check Cashier’s Check Money Order (Make payable to Fortune Hi-Tech Marketing, Inc.) Credit Card (Please complete additional information)

4. CREDIT CARD PAYMENT

To pay using a credit card, complete the below information. Address: Check here if address is same
Visa Cardholder Name: ____________________________________ ___________________________________ as above
MasterCard Zip Code: __________________ ___________________________________ Mother’s Maiden Name:
American Express Card Number:________________________________________ ___________________________________ _____________________________
Expiration Date: _____/________ Cardholder’s Signature:

CVC Number: _______ _________________________________________________

5. SIGNATURE
I hereby apply to become an Independent Representative for Fortune Hi-Tech Marketing, Inc. (FHTM). I have read carefully and agree to abide by all provisions of the Terms and Conditions which
are printed on the reverse side of this application and all published Policies and Procedures of FHTM. My sponsor has explained to me that purchase of the Special Services Program is optional,
is not required and is non-refundable after 10 days and that becoming a customer is not required. I understand that this agreement must be accompanied by a $75.00 refundable deposit (where
applicable) and that payment of the $75.00 refundable deposit is waived if I enroll in FHTM’s Optional Special Services Program. (This refundable deposit is not applicable to residents of Alabama,
Georgia, Kentucky, Louisiana, Minnesota, Nebraska, North Dakota, Pennsylvania, South Dakota, West Virginia or where prohibited by law.) I understand if I elect not to purchase the Optional
Special Services Program FHTM will supply, at no cost, a starter kit with necessary forms and applications within 30 days from the date requested.
I understand that the $75.00 refundable application deposit is waived if I have enrolled in the Optional
Special Services Program. A participant in this program has the right to cancel at any time, regardless of
x
reason. Cancellation must be submitted in writing to the company at its principal business address.
Signature Date
6. PLEASE CHECK APPROPRIATE BOXES

I prefer to be paid my commissions and bonuses by EFT (Electronic funds transfer). I prefer to be paid my commissions I authorize FHTM to give my phone
Attached is a voided check on the account I want deposits made to. and bonuses by check. number to my upline organization.

7. SPONSORSHIP INFORMATION FOR OFFICE USE ONLY

My Sponsor Is:
Amount Paid
Last Name First Name Ml Home Telephone Number
Check Number

Mailing Address (PO Box cannot be used) Business Telephone Number

Received By

City State Zip Sponsor I.D. Number Date

OPTIONAL: The Manager’s Sales Kit may be sent to the Sponsor at the address above.
INITIALS
(The newly sponsored Manager must approve by initialing this box.)

White-Fortune Yellow-Sponsor Pink-Representative DO NOT DUPLICATE FORM #100 5/2010

 880 Corporate Drive, Suite 200, Lexington, Ky 40503
Fax: 859.422.7036

New Representative Bundle Order Form

FHTM New Representative Bundles are available for Representatives who enroll in the business on or after April 1, 2010 to purchase within 60 days of their enrollment date. After
60 days, the bundle options will no longer be available for purchase, but Representatives can purchase products and services within the bundles individually at regular pricing.
With six product bundles from which to choose, you can select the one you believe will most interest your customers. You can sell these products directly or use them as samples
to show your customers who can then order these and other products from your Office Assistant.

To complete the New Representative Bundle Order Form, follow these steps:
1. Select the bundle you would like to purchase by checking the box next to the bundle name. Visit www.FHTMUniversity.com for more information on the individual bundles.
2. Select the products and services you would like within the bundle. Visit www.FHTMUniversity.com for product and service information. Details on True Essentials packs
within the bundles may be found on www.TrueEssentials.net. You may select more than one of the same True Essentials pack where applicable, but you may only select a
service one time.
3. Complete Representative Information and Credit Card Payment sections of the form.
4. Review the terms and conditions located on www.FHTMUniversity.com/507.aspx.
5. Sign your form to approve the credit card payment and acknowledge acceptance of the terms and conditions.
6. Fax the completed form to FHTM: 859.422.7036.
Please complete one form per New Representative Bundle order.

Quick Start Bundle 1 $89.99 + shipping/handling* 3 points Quick Start Bundle 2 $99.99 + shipping/handling* 3 points
Select one AND Select one Select one AND Select two
Cardio Health Pack Amusement Pack Cardio Health Pack Amusement Pack
Immune Support Pack Identashield Immune Support Pack Identashield
Fruit and Vegetable Pack Fruit and Vegetable Pack International World
Fitness & Energy Pack Fitness & Energy Pack Tour Golf
Anti Fungal Cleansing Pack Anti Fungal Cleansing Pack Roadside Auto Club

Save up to $20 in enrollment fees Up to $133.97 value Save up to $35 in enrollment fees Up to $173.96 value

Customer Plus Bundle 1 $129.99 + shipping/handling* 5 points Customer Plus Bundle 2 $134.99 + shipping/handling* 5 points

Qty. Select two** Select one Select three

Cardio Health Pack Amusement Pack
Cardio Health Pack
Immune Support Pack Identashield
Immune Support Pack
Fruit and Vegetable Pack International World
Fruit and Vegetable Pack
Fitness & Energy Pack Tour Golf
Fitness & Energy Pack Roadside Auto
Anti Fungal Cleansing Pack Anti Fungal Cleansing Pack
TrotHop
Free! Office Assistant and MyTelTag Messenger Free! Office Assistant and MyTelTag Messenger
Save up to $34.99 in enrollment fees Up to $250.93 value Save up to $114.93 in enrollment fees Up to $263.94 value

Get Qualified Bundle 1 $249.99 + shipping/handling* 10 points Get Qualified Bundle 2 $259.99 + shipping/handling* 10 points
Qty. Select two** AND Includes TrotHop
Qty. Select three** AND Select one
Cardio Health Pack Select three
Cardio Health Pack Amusement Pack
Immune Support Pack Amusement Pack
Immune Support Pack Identashield
Identashield
Fruit and Vegetable Pack International World Fruit and Vegetable Pack
Tour Golf International World
Fitness & Energy Pack Fitness & Energy Pack Tour Golf
Anti Fungal Cleansing Pack Roadside Auto Club Roadside Auto Club
Anti Fungal Cleansing Pack
TrotHop
Free! Office Assistant and MyTelTag Messenger Free! Office Assistant and MyTelTag Messenger
Save up to $74.98 in enrollment fees Up to $401.87 value Save up to $114.93 in enrollment fees Up to $381.89 value
* Taxes will apply, where applicable. **You may select more than one of the same TE pack by indicating the number you wish to include in your bundle in the quantity box.

REPRESENTATIVE INFORMATION

Last Name First Name Ml Representative ID -Required

Mailing Address PO Box cannot be used (This will be your shipping address for all product shipments.)
Home Telephone Number

City State Zip

Business Telephone Number

E-mail Address -Required

Fax Number

CREDIT CARD PAYMENT

To pay using a credit card, complete the below information. Address:
Visa Cardholder Name: ____________________________________ ___________________________________
MasterCard Zip Code: __________________ ___________________________________ Mother’s Maiden Name:
American Express Card Number:________________________________________ ___________________________________ _____________________________
Cardholder’s Signature:
Expiration Date: _____/________
CVC Number: _______ _________________________________________________
Your signature indicates that you have reviewed and agree to the terms and conditions located on www.FHTMUniversity.com/507.aspx.

6.2010