Sale of drugs, etc.

Agreement made this _________ day of _________, _________[date], between _________, of _________,
referred to as the principal, and _________, of _________, referred to as agent.

Principal is in the business of making and selling _________ and other products, and agent desires to be
appointed special selling agent of principal in the city of _________.

In consideration of _________, the receipt acknowledged, they agree as follows:

1. Principal appoints agent its special selling agent in the above-named place, and agrees not to sell its
products to any other dealer in that place so long as agent shall perform the terms of this agreement.

2. Principal agrees that if agent becomes dissatisfied with the agency, or should agent feel that any
misrepresentation has been made by principal, he [she, it] can, by notifying principal, return to principal any and
all merchandise agent may have on hand at the price the merchandise may have cost agent.

3. Principal agrees to keep a record of all advertising and other expenses directly charged to the territory of
agent, and to credit the record with all purchases, the record to be open to inspection of agent.

4. Agent agrees to uphold all of the products of principal to the full list retail prices set by principal, and to
never under any circumstances sell or allow the products to be sold to the wholesale or retail dealers except at
full retail price.

5. Agent agrees to confine the sale of the products of principal to his [her] own retail store and to consumers
only, and in the event of any violation of the terms of this paragraph or of preceding paragraph by agent or its
servants or agents, principal shall become entitled to and agent shall pay the sum of one hundred dollars for each
and every violation.