PURE HERBS, LTD. DISTRIBUTOR APPLICATION AGREEMENT 33410 Sterling Ponds Blvd. Sterling Heights, MI  48312  U.S.A. PHONE (800 ) 860-4372  (586) 446-8200 FAX (586) 446-8218


Last Name:

First Name                                         Middle Initial

Mailing Address:

City: (Please do not abbreviate)                                            



Zip Code:                             Country you live in:

Shipping Address (if different from above)

City: (We do not ship to Post Office Boxes)



Zip Code:                             Country you live in:

Check here if your shipping address is residential.

Check here if your shipping address is commercial (not attached to home)


Home phone number with area code:

Work phone number with area code:    Ext. Number

Applicants Social Security Number:    OR       Applicants Federal Tax ID. Number: (This information is necessary for  tax purposes only)
                 Bella Vladimirsky Sponsors Name: (Person who introduced you to the product)  When rejoining, if expired, we still need to know who will sponsor you.



                                                                    METHOD OF PAYMENT:      Credit Card Number:

 /// exp date:/
  V-Code   Billing Zip Code
           VISA                 MASTERCARD          CHECK OR MONEY ORDER (C.O.D.)     AMERICAN EXPRESS            DISCOVER
  Date:                                Check here:  If you would like us to put your credit card on file.
SIGNATURE OF APPLICANT  _____________________________________________



Applicant Signature on line above: (In order to process this application signature & tax information is required). I have read and agree to all the terms & conditions of the application agreement form located on this web-site. $35.00 fee

  Applications without signatures & tax information will not be processed.  Fee $35.00


1.) For tax purposes, the applicant must provide taxpayer identification number (this is normally the applicant's social security number).  The taxpayer identification number must match the name of the application.  Only one taxpayer identification number per household and/or business can be accepted .  Application must have your signature and your social security number or Federal tax Id number in order to process

2.) I am an independent contractor and not an employee, agent, or representative of PURE HERBS, LTD. Therefore,  I am solely responsible for my own business.

3.) I will obey all laws pertaining to the operation of my business including, but not limited to, paying all fees and taxes due any local, state or federal agencies.

4.) I will purchase product and conduct my business according to the procedure published in the PURE HERBS, LTD. MARKETING PLAN.

5.) I will never make any claims, statements or advertisements concerning PURE HERBS, LTD. or any of its products    except those that have been officially approved in writing by the company. I understand that herbs and PURE HERBS, LTD. herbal products are foods and should be represented as such. They cannot be used to treat or cure disease.

6.) Due to F.D.A. regulations regarding food products, PURE HERBS, LTD. has a no return policy. The exceptions are breakage and manufacturing defects. This policy is necessary, as the returned product must be destroyed.

7.) I may sponsor persons into the PURE HERBS, LTD. DISTRIBUTION PROGRAM without cost or investment, provided PURE HERBS, LTD. accepts their application. PURE HERBS, LTD. reserves the right to deny any application.

8.) PURE HERBS, LTD. reserves the right to terminate this DISTRIBUTOR AGREEMENT, upon 30 days prior written notice, should the undersigned violate any of the terms and conditions of this DISTRIBUTOR AGREEMENT, any published rule of PURE HERBS, LTD., or any of the provisions of the PURE HERBS, LTD. MARKETING PLAN. Furthermore, PURE HERBS LTD., reserves the right to set off against any monies due and owing to the undersigned by PURE HERBS, LTD. any money due and owing by the undersigned   downline or for any other violation of the undersigned of this DISTRIBUTOR AGREEMENT or the aforementioned published rules or MARKETING PLAN of PURE HERBS, LTD.

9.) PURE HERBS, LTD. reserves the right to amend the MARKETING PLAN upon 30 days notice to existing Distributors.

10.) PURE HERBS, LTD. HAS AN APPLICATION FEE OF $35.00  (due when turning the application in to PURE HERBS, LTD.) and a yearly Distributorís renewal fee of $20.00 (due each year following your initial sign up). This renewal fee shall be used to cover the costs of newsletters and materials sent to the Distributor. The applicant is responsible for mailing or faxing this Application Agreement and his/her application fee to the company.  PURE HERBS, LTD. will not accept any altered Application Agreement Forms.   Incomplete applications will not be processed & will be sent back to the applicant.

11.) I am eighteen years of age or older.

12.) Applications must be mailed or faxed in, we cannot take phone applications.