FM GROUP NIGERIA

Distribution Contract
(An application for joining the FM Club)

Sponsor's number:
Sponsor's first name and surname:

Surname:
Firstname:
Date of birth (dd-mm-yyyy):
Date of joining to FM CLUB (dd-mm-yyyy):
I'm a VAT payer:	Yes No

Company Name:
Full private or registered address:

Mailing address:

Home phone number:
Mobile phone number:
E-mail address:

Personal document number: (passport number, insurance number or driving licence number)
Taxpayer identification number (optional):
Full bank name and account number:

Payment detail:

Bank:
Date of payment:
Teller no:
Amount Paid:

I declare, that I have made myself acquainted with the rules that apply to FM Club Member which I accept voluntarily and I commit myself to obey them. I also aggre my personal details to be processed and made available to the companies that perform shipment services for the FM, I agree my personal details and the data concerning my due bonuses and discounts to be transferred to the distributors that are included in the same distribution group.

I agree general rules of joining the FM GROUP Club

I also agree: my personal details to be processed and made available to other Club Members situated in the structure of my network as well as I put forward a motion to make the data from the personal details database available according with rules that apply to FM Club Member.

Yes No

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