Alliance in Motion Global. Inc.Unit 301 & 320 3/F AIC-Burgundy Empire Tower, ADB Ave, cor. Sapphire & Garnet Sts. Ortigas Centerm Pasig City, Philippines

DISTRIBUTOR APPLICATION FORM

Personal InformationUSER NAME

LAST NAME FIRST NAME MIDDLE NAME

Address

Birthdate Age StatusMM DD YYYY

Home Telephone No. Mobile No.

E-mail Address

Beneficiary Age Relationship

GLOBAL PACK SALES INFORMATIONSponsors Name Sponsor ID No.

Placement Name Placement ID No.

Position L R

Signature of Sponsor Signature of Appllicant

PAYMENT INFORMATION GLOBAL PACK PACKAGECheck Cash

C24 / 7

Amount Business Kit

VCD Brochure DAF

Signature Date Endorsement Letter

For and behalf of Scholarship

www.allianceinmotion.com

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