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Welcome to the Univera AgelessXtra Matol Botanical Wholesale Discount Enrollment Center
With Over 25 Years of family Health Products !


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matol botanical intl registration,



Matol Botanical International Distributor Robert Veliky

robert@matolproducts.com

Just fill out this form to enroll for wholesale prices!
Section A

Business Name:

Applicant A

Federal I.D. Number/SSN/SIN: Date of Birth: Month/day/year
Last Name: Language Preferred:
English French Spanish
First Name:

Middle Initial:

Occupation:
Mailing Address:

City:

State/Prov: Zip/Postal Code:

Shipping Address:

State/Prov: Zip/Postal Code:

City:

Home Tel:
Business Tel:
Fax:
E-Mail:

Applicant B

Federal I.D.
Number/SSN/SIN:
Last Name:
First Name:
Middle Initial:
Occupation:
Relation of applicant A to B: Spouse Relative Friend/Business Associate

Has either Applicant A or B previously had an interest in a Matol Botanical International Ltd. Independent Distributorship?
Yes No

If you wish to benefit from special services offered by Matol Botanical International, Ltd., please indicate if you have a:

Distributer Hearing Imparement
(Deaf/Hard of Hearing)
Visual Imparement (Blind) Physical Imparement (Wheelchair) Other Imparement
A
B

Section B

Enroll Me As A Univera Matol Associate Member :
Please check box Rush My Business building kit for:$40 + S/H Start A Home Business
Purchasing Products At WHOLESALE, With Business Building Tools!


Include Some Products With Your Registration? You Can Save Money Right Now!
A Minimum Order Of 40 Commissional Points with Your Registration In order to receive the Wholesale price.
Just Copy From The List Below And Paste It Here.

Visa Mastercard International
Money Order*
Certified Check*
I authorize Univera Matol Botanical International Ltd. to debit my Visa/Mastercard

Credit Card No.
Name of Card Holder: 3 Digit Security Code located on Back of card
Right hand side
Expiration Date

Please Note:
This Distributor Registration & Agreement Form cannot be processed unless this section has been fully completed. You May PRINT Out This Form Also And Mail To Univera MATOL

When you * Mail Certified cheques or International money order accompanied with ID# to home office with the Registration and Agreement Form. And/or If including products call 1-800-363-1890 to have your shipping charges calculated For where you live

or email me ! and I will let you know what the total cost is
please include your shipping address when you inquire!

Send Too: Univera Matol botanical.
Montreal: 290 Labrosse Ave – Pointe-Claire, PQ H9R 6R6

Just leave this section blank I will Take care of this!
Section C
Sponsor Information
MB Federal I.D. Number/SSN/SIN:
Last Name: First Name:
Home Tel:
Business Tel:
Fax:
E-Mail:

Section D
This is already filled out for you!

Enroller Information - Distributor Introducing Applicant to Matol

MB Check here if enroller is also Sponsor (If not, complete this section)
Last Name: First Name:
Home Tel:
Business Tel:
Fax:
E-Mail:
We request that all checks for monies earned be issued in: Applicant A's Name Applicant B's Name
Please note: If registered under a business name, cheques will automatically be issued under the business name.


Please read the agreement terms here before submitting this form

I hereby declare that I have read the terms of this Agreement form and that I fully understand and agree to abide by all said
terms. Moreover, I am entitled to cancel my participation in the marketing plan at any timeand for any reason, upon receipt of my written notice by Matol Botanical International Ltd.

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