Africa’s Garden
269 South Beverly Drive Suite 1072

Beverly Hills California 90212 (310) 271- 0554 (888) 264 -0888

 

Independent Contractor’s Representative Application Agreement

(Please assist us in processing your application, print clearly)

 

First Name ______________________________________________Last Name__________________________________________________

 

Contact Phone Number__________________________________________ E Mail Address ________________________________________

 

Social Security Number _______________________________________ Start Date ______________________________________________

 

Billing Address (NO Post Office Boxes No Exceptions!)

__________________________________________________________________________________________________________________

 

City_______________________________________________ State_____________________________ Zip Code _____________________

 

 

Select and Circle A Garden Representative Package For You New Business Investment
(Discount is for Your First Purchase Only. Please Select the Fragrance You Want and Write it Below)

 

□ Garden Girl Platinum Package $800      □ Garden Girl Basic Package $110         
□ Copper Leaf Platinum Package $800      □ Copper Leaf Basic Package $145

□ Garden Girl & Copper Leaf Package $255  □ Work with Catalog & Invoice & Sample Size Kit $49.99     
□ Create Your Own Package $100 Minimum (Package Discounts Do Not Apply. Full Retail Price only)

 

Billing Information: Please Circle One of the Following Below (Do Not Send CASH in the Mail Please)

 

MASTER CARD                                    VISA CARD                                        ATM DEBIT CARD                          MONEY ORDER  

 

Credit Card Number ___________________________________________Card Holders Full Name___________________________________

 

Expiration Date ____________________________________________ 3 digit number on back of credit card ___________________________

 

SUBTOTAL ______________________________________ (Total Amount Must Match a Spa Package)

 

SHIPPING & HANDLING FEES (Add $8.00) ______________________________SALES TAX % IN YOUR STATE______________________

 

FINAL INVESTMENT TOTAL __________________________________________

 

 

I (print name) ____________________________________ have read and agree to the terms and policy for becoming an Independent Representative. I agree that I am over 18 years of age because my Date of Birth is _________________. I understand that I am an independent contractor and Not an employee of Africa’s Garden and shall Not be treated as an employee of Africa’s Garden for Federal or State Tax purposes. I agree to have the total amount listed above charged to my credit card. I agree to have my package shipped to the address I have provided above or another shipping location on this agreement. I understand that my package will be shipped to me from Africa’s Garden once this form is faxed to the number above or sent certified mailed to the Africa’s Garden address listed above. I agree that there are no refunds, except if I receive a product from Africa’s Garden with a defect only. I will report the damage or defect within 24 hours of receiving it to receive a credit or a replacement.  I agree to this at my own free will and understand that this is my business investment. I understand and agree that Africa’s Garden may terminate this Agreement at any time with or without reason, upon written notice to me.

 

 

Independent Representative Signature _______________________________________________________________

 

Today’s Date ___________________________________________________________________________________

 

 

A Representative from Africa’s Garden will call you on the number listed above to confirm your package order and review your application.