BUSI

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ENTIT

Y APP

LICAT

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MEMBERSHIP APPLICATION & AGREEMENT FOR BUSINESS ENTITY

ApplicAnt informAtion
name of Business Entity

contact person

Business Office Adress

City

State

ZIP Code

Email Address

Business phone

cell phone

Member ID Number Federal Tax ID number of Business Entity

Propietorship doing business under a Registered Fictious Name corporation partnership trust other - (Describe)

Federal Tax ID number of Business Entity

SponSor informAtion
name Identities of ALL Owners are necessary. There must be one completed entry for shareholder and/or Owner. name title member iD

Daytime phone

cell phone

Business Office Adress

City

State

ZIP Code

Email Address Lyoness America, Inc., 350 Fifth Avenue, Suite 2710, New York NY 10118

www.lyoness.net

TERMS AND CONDITIONS

1. If you are Registering your Business as a Member, this Application and Agreement must be completed and submitted with your Member Application and Agreement. 2. Any transfers of ownership interests in the Members business entity are subject to Lyoness Policies and Procedures. See Lyoness Policies and Procedures for a description of the Transfer Policy. All members, managers, shareholders, trustees, partners, or others with any ownership interest in the business entity (collectively Owners) shall be jointly and severally liable for all contracts entered into with Lyoness. Each Owner is individually bound to, and must comply with, the terms and conditions of the Lyoness Member Application and Agreement. As legal representatives of the entity, any violation of the Lyoness Member Agreement by any Owner(s)Member(s) or person(s) of the Business and/or having managerial responsibility of the Business Entity, shall be jointly and severally liable for their actions at all times. Failure to list all appropriate persons on this Application and Agreement shall be grounds for Lyoness to terminate this agreement or invoke other actions and/or sanctions as described in the Member Agreement. Transfers of ownership interest of a Lyoness Members business that is owned by the business entity is subject to the Lyoness Member Agreement. See the Member Agreement for a description of the Transfer Policy. This Form, along with a properly completed IRS form W-9 (available at www.irs.gov/pub/irs-pdf/fw9.pdf) must be sent to Lyoness within 30-days of the entitys enrollment as a Lyoness Member. If Lyoness does not receive this Form and the W-9 within the 30-days, the Member Application and Agreement of the Business Entity shall be subject to termination. 17. I authorize Lyoness to use my name, photograph, personal story and/or likeness in advertising or promotional materials and waive all claims for remuneration for such use. 18. A faxed copy or a scanned emailed copy of the Agreement shall be treated as an original in all respects.

Applicants Signature

Date

Co-Applicants Signature

Date

Co-Applicants Signature

Date

www.lyoness.net