Distributor Registration

List Market Criteria to be a Distributor

Criterion 1
Criterion 2

Agree with the contents of the summary document

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I agree to the terms of the written summary

I am a Japanese Citizen
(If you are not a Japanese Citizen you must enroll by calling customer support at 1.888.XXX.XXXX)

Please enter your 6-digit PIN code

Business Account Information

TARO YAMADA
Partner: MAKKO YAMADA

Please Verify Your Information:
(If you need to change this information, please call Customer Support at 1.888.XXX.XXXX)

Sponsor Information:

Taro Yamada
JA1111111

Distributor Information

山田太郎
TARO YAMADA
Man
May 06, 1989

Address

〒 534-0026
1-2-27クリスタルタワー24F
大阪府大阪市町

Phone

056-1234-1234 (mobile)

Email Information

watarunakashima@gmail.co
(no email preference)

Partner Information

Name (Kana)

Name (Kanji)

Name (Roman)

Gender

Man

Woman

Birthdate

Bank Account Information

Bank of America, Provo UT Branch
Acct#: XXXXXXX1234 - Checking

Bank Code

Branch Code

Enter Bank Information Manually

Bank Institution Name

Branch Name

Account Name

Account Number

Checking Account

Savings Account

Terms and Conditions

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I agree to the terms and conditions