Class One
Exclusive Distributor 
Indivisual’s / Business Net Worth:
How much capital do you have available to invest in this business?

In which geographical areas would you like to purchase the exclusive regional distribution right? (the preferred region should not be smaller than a county)

After getting preliminary approval, where can the applicant get initial training?
After getting preliminary approval, when can the applicant get initial training?

Please sign below to indicate that the facts you have given are accurate to the best of your knowledge and belief and may be used by A4L to verify your information and your suitability as an A4L exclusive regional distributor. You agree that omission or misrepresentation of information in this form may result in your removal from the A4L application.

Thanks for your order!