Organo Gold International, Inc.

Appli- (*) Mandatory

* Social Security # * First Name * Last Name Middle Initial

Billing Address Shipping Address * Number and Street

Address Line 2 (Suite or Apartment no.)

* City

* Daytime Phone

* State * Zip Code * Country

Evening Phone Fax Number

* Number and Street

Address Line 2 (Suite or Apartment no.)

* City

* Daytime Phone

* State * Zip Code * Country

* Email address:

Organization Information

* Tax ID # * Organization Name * Contact Phone

* Enrolling Sponsor

* Sponsor’s OG ID #

* Sponsor’s

* Placement (Select one)

Left Right

5 5 0 5 H o v a n d e r R d . F e r n d a l e , W A 9 8 2 4 8

NonProfit / Health Care Practitioner Free Signup USA Representative

MUST be Accompanied by an Initial Order OGF_10-013

PAYMENT Item

Description Order

Qty Autoship

Qty

(112) OG Variety Case (6 black 6 mocha 6 latte 6 hot chocolate 6 green tea) (113) OG Green Tea Case (30 boxes) (114) OG Hot Chocolate Case (30 boxes) (115) OG Black Case (30 boxes) (116) OG Mocha Case (30 boxes) (117) OG Latte (30 boxes) (118) OG Combo Case 1 (10 black 10 mocha 10 latte) (119) OG Combo Case 2 (15 black 15 latte)

FREE SHIPPING CASES

$576.00 $660.00 $600.00 $510.00 $600.00 $510.00 $540.00 $510.00

FREE SHIPPING FOR CASES and For Orders 500 PV above (Prices are in USD)

Credit Card Number

Card Holder Name

Exp Month CCV Exp Year

Note: All Orders Will Be Charged Applicable Taxes, Shipping and Handling

Visa MasterCard AMEX

Fax to 1-604-288-5488 or Email to: support@Organogold.com

NONE 1st 15th

Shipped the

of the following month

AUTO-SHIP DATE (If Applicable)

UNIT COST

$17.00 $20.00 $17.00 $20.00 $22.00 $22.00 $34.00 $41.00 $41.00 $66.00 $41.00 $24.00 $37.00 $14.00 $54.00 $108.00 $96.00 $189.00

(501) OG Gourmet Black (502) OG Gourmet Mocha (503) OG Gourmet Latte (504) OG Gourmet Hot Chocolate (505) OG Organic Green Tea (507) OG Café Supreme (508) OG Royal Brewed (801) OG Organic Ganoderma (802) OG Pure Mycelium (803) OG Organic Ganoderma Spores (804) OG Grapeseed Oil Extract (905) OG G3 Soap 3 Pack (907) OG Smile Sampler (10 small tubes x 30g each) (908) OG Smile (1 large tube x 150g each) (106) OG 3 Pack (1 black,1 mocha 1 latte) (107) OG 6 Pack (2 black 2 mocha 2 latte) (306) OG 5 Pack (1 black 1 mocha 1 latte 1 hot chocolate 1 green tea) (800) OG Capsule Pack (1 ganoderma 1 mycelium 1 spores 1 grapeseed)

Representative Agreement (Please Read and Sign)

I/we acknowledge that I/we have carefully read all of the Terms and Conditions. I/we understand the Terms and Conditions con-tained herewith along with the Statement of Policies & Procedures, which by reference are fully incorporated in this document, and agree to be bound by them.

I/we also understand that I/we may terminate my/our Independent Organo Gold Representative status at any time with written notice to Organo Gold. I understand that it is my responsibility to ensure that product sales, as well as payment for such sales, are processed prior to the end of a com-mission period to be eligible for a commission.

Applicant’s Signature

Date Co-Applicant’s Signature

Date

Organo Gold International, Inc.

NonProfit / Health Care Practitioner Free Signup USA Representative

MUST be Accompanied by an Initial Order

5 5 0 5 H o v a n d e r R d . F e r n d a l e , W A 9 8 2 4 8

Independent Organo Gold Representative Application and Agreement Terms and Conditions

I/we acknowledge that I/we have carefully read all of the Terms and Conditions. I/we understand the Terms and Conditions contained herewith along with the Statement of Policies & Procedures, which by reference are fully incorporated in this document, and agree to be bound by them. I/we also understand that I/we may terminate my/our Independent Organo Gold Representative status at any time with written notice to Organo Gold. I understand that it is my responsibility to ensure that product sales, as well as payment for such sales, are processed prior to the end of a commission period to be eligible for a commission. 1. First and foremost, Organo Gold International Inc. is built on a foundation of integrity, edification and trust. Whether dealing with my customers, fellow Representatives or the Company, I will build my business on this same foundation. If anything comes to my attention that detracts from this, I will deal with it immediately, first through my upline organization, then to the Company if necessary. I will not allow any attempt to destroy the foundation; disparagement toward my fellow Representatives or Organo Gold in any form will not be tolerated. 2. I certify that I am at least 18 years of age (or age of majority) and understand the Agreement is not binding until received and accepted by Organo Gold. 3. I agree to operate my business in accordance with all the rules, regulations, policies and procedures as set forth by Organo Gold in its Statement of Policy & Procedure (SOPP), a copy of which is available in my back office, and in any amendments, supplements, or replacements in the future. 4. I will become an Independent Contractor (Representative) upon acceptance of this application by Organo Gold. As an Representative, I shall have the right to sell the products and services in accordance with Organo Gold’s compensation plan. 5. I understand that I will be responsible for obtaining all necessary licenses and permits and for complying with all applicable federal, state and/or municipal laws, codes and regulations in connection with my activities as an Organo Gold Representative. I acknowledge that I am not an employee of Organo Gold and shall not be entitled to receive from Organo Gold any benefits whatsoever and Organo Gold shall not be required to make contributions for FICA, workers compensation and other similar levies in respect of payments to be made to me as a Organo Gold Representative. I will be fully responsible for paying all applicable federal or state withholding taxes, source deductions, taxes, employment insurance premiums, workman’s compensation contributions or other tax contributions and other premiums, license requirements and fees related to my activities as a Organo Gold Representative. 6. I acknowledge that as a wholly independent Representative, I am not purchasing a franchise or exclusive distributorship, and no fees are or will be required from me for the right to distribute Organo Gold’s products pursuant to this agreement, with the exception of $49.95 OG Business Kit, which is non-commissionable, and provided a company cost. I acknowledge that this agreement may not be assigned or transferred without written consent from Organo Gold. 7. As a Representative I will abide by any and all Federal, state and local laws, rules and regulations pertaining to this Agreement and/or the acquisition, receipt, holding, selling, distribution, or advertising of Company products. 8. As a Representative I will, at my own expense make, execute or file all reports and obtain licenses required by law or public authority with respect to this Agreement and/or the receipt, holding, selling, distributing of Organo Gold Products. 9. I will be solely responsible for declaration and payment of all local, state, and Federal taxes as may accrue because of my independent business activities in connection with this Agreement. I acknowledge that Organo Gold reports all my commissions, rebates, and bonuses to the appropriate regulatory agencies in the United States, as required by law. 10. I understand that this Agreement shall automatically renew annually provided that I have maintained active status as an Representative by generating a minimum of 50 PV (point value) in a rolling five week period including the current week. Organo Gold has my permission to charge the credit card on record the current renewal fee on or before my anniversary date unless I cancel my Representative status in writing to the Company.. 11. I further understand that all rights to bonuses, rebates and commissions; my Organo Gold business; and the opportunity to purchase products from Organo Gold shall immediately be subject to termination should my status become inactive. 12. I understand that I am entitled to cancel participation in the marketing program at any time and for any reason upon written notice to Organo Gold. Following the notification of cancellation or termination, the sponsoring Representative or Organo Gold will repurchase inventory and mandatory starter kit materials in accordance with the policies as stated in Organo Gold’s Statement of Policy. 13. I certify that neither Organo Gold nor my sponsor have made any claims of guaranteed earnings or representations of anticipated earnings that might result from my efforts. I understand that I may not make any verbal or written statements regarding claims of income or potential earnings that might result from my efforts or the efforts of others, unless specifically disclosed in a compensation summary provided from time to time by the Company. 14. I understand that no attorney general or other regulatory authority reviews, endorses, or approves any product, membership, compensation program, or company, and I will make no such claims to others. In the event a question shall arise concerning legal compliance by Organo Gold, such questions shall be submitted to Organo Gold in writing. 15. I agree to indemnify and to hold Organo Gold blameless from any and all claims, damages, and expenses, including attorney fees, arising out of my actions and conduct in violation of this Agreement.

16. In sponsoring other Representatives, I agree to fulfill the obligations of performing a bona fide supervisory function in the sales and distribution of product to the ultimate consumer and in the training of those Representatives I sponsor. I will maintain ongoing contact, communication and management supervision in my sales organization. Examples of this supervision may include but are not limited to, newsletters, written correspondence, personal meetings, telephone contact, voice mail, electronic mail, training sessions, accompanying individuals to company trainings, proper use of compensation summaries regarding earnings representations and sharing distribution information with those sponsored. I will be able to provide evidence to the company semiannually of my ongoing fulfillment of these responsibilities. 17. I understand that Organo Gold’s program is built upon retail sales to the ultimate consumer. I am entitled to purchase product for my own personal or family use, and I understand that Organo Gold policy prohibits the purchase of product or large quantities of inventory solely for the purpose of qualifying for bonuses or advancement in the marketing program. Likewise, I will not encourage others in the program to purchase excessive inventory. I understand that I must fulfill published personal and downline sales requirements as well as supervisory responsibilities to qualify for the bonus overrides and advancements. 18. In the event that I wish to terminate my Independent Representative status, I may return any unused, unopened, and resalable products purchased within 60 days of the invoice date for refund, and will receive the invoiced amount, less a 10% restocking fee and appropriate set-offs for bonuses, rebates, commissions, and other charges. "60 days" becomes "90 days" in MD and PR, and becomes "one year" in GA, IA, LA, MA, MT, OK, TX, and WY and any additional requirements of the buy-back laws of the mentioned jurisdictions will be honored. Additionally, Montana Independent Representatives who cancel within 15 days are entitled to a 100% refund of any consideration given to participate. Beyond the two dates, I understand that Organo Gold will not accept any returns for product. 19. On a periodic basis, Organo Gold may supply confidential information in the form of genealogies, reports, and other sensitive material, which will provide information to me as an independent Representative concerning my organization. I agree upon receipt of said information that such information is proprietary and confidential and will not disclose such information to any third party directly or indirectly nor use the information to compete with Organo Gold either directly or indirectly. 20. I understand and agree to remit any Sales Tax based on the retail price of the product to the company on all product orders unless tax exempt. 21. I agree that I may not alter, repackage, re-label, affix additional labels of information or otherwise change any Company product, nor will I sell any such product under any other name. 22. I understand and agree that all claims and disputes relating to this Agreement, the right and obligation of the parties or any other claims or causes of actions relating to the performance of either party under this Agreement and/or purchase of products or services shall be settled by binding arbitration in the City of Ferndale, Washington, in accordance with the Commercial rules of the American Arbitration Association. Jurisdiction and venue shall be Ferndale, Washington. Each party having a concern shall first give notice of the offense and allow at least thirty (30) days for the other party to cure. In the event of a dispute, the prevailing party shall be reimbursed its costs and attorney's fees. Louisiana residents may choose jurisdiction and venue in New Orleans, Louisiana. 23. I agree that regardless of the form of claim, whether in tort, contract or other, the Company, its subsidiaries and affiliated companies and their officers, directors, employees and agents shall NOT be liable for any consequential, incidental, special, or punitive damages, including lost profits or any other claims against the Company. No legal action maybe brought by either party to this Agreement more than one year after the event giving rise to the cause of action has occurred. 24. I certify the accuracy of all information provided by me in this Agreement and agree that the providing of false or misleading information authorizes the Company, at its election, to declare this Agreement void from its inception. 25. I will make no claims of therapeutic or curative properties regarding the Company products or claims involving the Organo Gold Compensation Plan that are NOT contained in official Company literature that is produced and distributed by the Company. Sponsors are compensated for the sale of Products and those Products sold through their ales organization. No OG Representative will ever be compensated for sponsoring. Without question, the sale of products to end consumers is the basis of the Company’s program and must be emphasized in all presentations. Representatives may not make any claims as to any therapeutic or curative properties of the Company’s products. The Company’s products are not intended to diagnose, treat, cure, Prevent, or mitigate any disease and should never be offered as such. Representatives shall not suggest any diagnosis, prognosis, evaluation, treatment, description, management or remedy of illness, ailment or disease. Representatives may not make any false, unreasonable, misleading, or intentionally misrepresenting income projections to prospective or current Representatives. Under no circumstances may OG Representatives recruit other OG Representatives for other Business Opportunities. The Company reserves the right to Accept or Reject any applicant and is under no obligation to offer any reason for rejection. If an Application is submitted through the Internet will be Considered an original application. Incomplete applications will not be accepted and are the sole responsibility of the Applicant. The Company is under no obligation to notify an applicant of an incomplete or faulty application.