Please make a copy of this original and retain it for future use.

Fill out the copy and mail it to the address listed below or fax it to 801.409.8079

U.S. Independent Distributor Application and Agreement

Applicant Information
first name date of birth middle initial co-applicant or business name co-applicant social security number (or federal tax ID number) city fax mobile (not required) recruiting sponsor ID# email address state zip

FORM 101
applicant last name (please print) applicant social security number (or federal tax ID number) address (street) phone upline sponsor ID#

month

day

year

Date:

Check Appropriate Boxes:

Individual/Sole Proprietor

Joint Applicants

Partnership

LLC

Corporation

Other

If you select Partnership, LLC, or Corporation please fill out aStatement of Beneficial Interest Form [FORM 105] and fax it in with this Application.

Automatic Renewal Program (ARP) and SISEL Distributor Kit

I understand that I can elect to automatically renew my SISEL Distributorship on the anniversary date of my Distributor Agreement. By checking the appropriate box, I authorize SISELto charge my credit card or my e-wallet for the amount of the regular renewal fee (currently $15.00) in order to automatically renew my Distributor Agreement. I also understand that if I do not wish to participate in the Automatic Renewal Program I must check the appropriate box below and manually renew my SISEL Distributorship on or before each anniversary date, in order to continue my Distributor Agreement and remain a SISELDistributor.

Please bill my credit card

Deduct from commissions (e-wallet)

I do not wish to participate in the Automatic Renewal Program.

I agree that in conjunction with my application to become an independent distributor for Sisel International LLC, I will purchase at least one Sisel Distributor Kit (currently $20.00twenty U.S. Dollarsplus any applicable tax). I authorize Sisel International, LLC to charge the card indicated below for my Sisel Distributor Kit (s)

VISA MASTERCARD DISCOVER AMEX

name as shown on card

credit card number signature of cardholder

exp

month

year

Terms and Conditions

1. I understand that as a SISEL International LLC and affiliates (hereafter SISEL) Distributor: (a) I have the right 5. (cont.) of my SISEL business and any activities related to it (e.g., the presentation of SISEL products or SISELs to offer for sale SISEL products and services in accordance with these Terms and Conditions; (b) I have the Dynamic Compensation Program, the operation of a motor vehicle, the lease of meeting or training right to enroll persons in SISEL; (c) I will train and motivate the distributors in my downline marketing facilities, etc.), and agree to indemnify SISEL for any liability, damages, fines, penalties or other awards organization; (d) I will comply with all national and local laws, rules and regulations and shall make all arising from any unauthorized conduct that I undertake in operating my business; (d) The Agreement, in reports and remit all withholdings or other deductions as may be required by national and local laws; (e) I its current form and as amended by SISEL at its discretion, constitutes the entire contract between SISEL will perform my obligations as a Distributor with honesty and integrity. and myself. Any promises, representations, offers or other communications not expressly set forth in the 2. I agree that as a SISEL Distributor I am an independent contractor, and not an employee, agent, partner, legal Agreement are of no force or effect; (e) Any waiver by SISEL of any breach of the Agreement must be in representative, or franchisee of SISEL. I am not authorized to and will not incur any debt, expense, obligation, writing and signed by an authorized officer of SISEL. Waiver by SISEL of any breach of the Agreement by or open any checking account on behalf of, for, or in the name of SISEL. I agree that I will be solely responsible me shall not operate or be construed as a waiver of any subsequent breach; (f) If any provision of the for paying all expenses incurred by myself, including but not limited to travel, food, lodging, secretarial, Agreement is held to be invalid or unenforceable, such provision shall be reformed only to the extent office, long distance telephone and other expenses. I UNDERSTAND THAT I SHALL NOT BE TREATED AS AN necessary to make it enforceable, and the balance of the Agreement will remain in full force and effect; EMPLOYEE OF SISEL FOR FEDERAL OR STATE TAX PURPOSES. SISEL is not responsible for withholding, and (g) If I wish to bring an action against SISEL for any act or omission relating to or arising from the shall not withhold or deduct from my bonuses and commissions, if any, FICA, or taxes of any kind. Agreement, such action must be brought within one year from the date of the alleged conduct giving rise 3. I have carefully read and agree to comply with the SISEL Policies and Procedures and SISELs Dynamic to the cause of action. Failure to bring such action within such time shall bar all claims against SISEL for Compensation Program and Terms, both of which are incorporated into and made a part of these Terms and such act or omission. I waive all claims that any other statutes of limitations applies; (h)In submitting Conditions (these three documents shall be collectively referred to as the Agreement). I understand that I this application, Distributor warrants that he is not violating the terms of any other agreement he may must be in good standing, and not in violation of the Agreement, to be eligible for bonuses or commissions have with any other individual, company, or business and agrees to indemnify SISEL against liability and from SISEL. I understand that these Terms and Conditions, the SISEL Policies and Procedures, and SISELs damages in any action with said individual, company, or business; (i) I authorize SISEL to use my name, Dynamic Compensation Program may be amended at the sole discretion of SISEL, and I agree that any such photograph, personal story and/or likeness in advertising or promotional materials and waive all claims amendment will apply to me. Notification of amendments shall be published in official SISEL materials for renumeration for such use; ( j) A faxed copy of the Agreement shall be treated as an original in all including company website. Amendments shall become effective 30 days after publication. The continuarespects. tion of my SISEL business or my acceptance of bonuses or commissions shall constitute my acceptance of 6. This Agreement will be governed by and construed in accordance with the laws of the State of Utah, any and all amendments. I agree to present SISELs Dynamic Compensation Program and SISEL products and without regard to principles of conflicts of laws. All disputes and claims relating to SISEL, the Distributor services as set forth in official SISEL literature. Agreement, SISELs Dynamic Compensation Program or its products and services, the rights and 4. The term of this agreement is one year. If I fail to annually renew my SISEL business, or if it is cancelled or obligations of an independent Distributor and SISEL, or any other claims or causes of action relating to terminated for any reason, I understand that I will permanently lose all rights as a Distributor. I shall not be the performance of either an independent Distributor or SISEL under the Agreement or the SISEL Policies eligible to sell SISEL products and services nor shall I be eligible to receive commissions, bonuses or other and Procedures shall be settled totally and finally by arbitration in Provo, Utah, or such other location as income resulting from the activities of my former downline sales organization. In the event of cancellation, SISEL prescribes, in accordance with the Federal Arbitration Act and the Commercial Arbitration Rules of termination or nonrenewal, I waive all rights I have, including but not limited to property rights, to my the American Arbitration Association, except that all parties shall be entitled to discovery rights allowed former downline organization and to any bonuses, commissions or other renumeration derived through the under the Federal Rules of Civil Procedure. All issues related to arbitration shall be governed by the sales and other activities of my former downline organization. SISEL reserves the right to terminate all Federal Arbitration Act. The decision of the arbitrator shall be final and binding on the parties and may, Distributor Agreements upon 30 days notice if the Company elects to: (1) cease business operations, (2) if necessary, be reduced to a judgment in any court of competent jurisdiction. The prevailing party shall dissolve as a business entity or (3)terminate distribution of its products and/or services via direct selling be entitled to receive from the losing party, according to the decision of the arbitrator, costs and expenses channels. of arbitration, including legal and filing fees. This agreement to arbitrate shall survive any termination or 5. I understand that: (a) If I fail to comply with the terms of the Agreement, SISEL may, at its discretion, impose expiration of the Agreement. Nothing in the Agreement shall prevent SISEL from applying to and upon me disciplinary action as set forth in the Policies and Procedures. If I am in breach, default or violation obtaining from any court having jurisdiction a writ of attachment, a temporary injunction, preliminary of the Agreement at termination, I shall not be entitled to receive any further bonuses or commissions, injunction, permanent injunction or other relief available to safeguard and protect SISELs interest prior whether or not the sales for such bonuses or commissions have been completed; (b) I may not assign any to, during or following the filing of any arbitration or other proceeding or pending the rendition of a rights or delegate my duties under the Agreement without the prior written consent of SISEL. Any attempt decision or award in connection with any arbitration or other proceeding. to transfer or assign the Agreement without the express written consent of SISEL renders the Agreement 7. The parties consent to jurisdiction and venue before any federal or state court in Utah County, State of voidable at the option of SISEL and may result in termination of my business; (c) SISEL, its directors, officers, Utah, for purposes of enforcing an award by an arbitrator or any other matter not subject to arbitration. shareholders, employees, assigns and agents (collectively referred to as affiliates), shall not be liable for, and Louisiana Residents Only: Notwithstanding the foregoing, Louisiana residents may bring an action I release SISEL and its affiliates from, all claims for consequential and exemplary damages. I further agree to against the Company with jurisdiction and venue as provided by Louisiana law. release SISEL and its affiliates from all liability arising from or relating to the promotion or operation I have read and agree to the following Terms and Conditions and hereby agree to abide by all terms set forth. I have read and agree to SISELs current Policies and Procedures as found on the companys web site, www.siselinternational.com, and in its official literature. I understand that I have the right to terminate my SISEL Distributorship and cancel my Distributor Agreement at any time, with or without reason, by sending written notification to the attention of SISELs Compliance Department, at the address listed on this form. I certify that I am of majority age and am legally able to enter into this contract. I further certify by signing this agreement that I have not performed in any other Distributorship with the Company for the previous six months, nor do I have an interest in any existing Distributorship with the Company. applicant signature co-applicant signature

ITEM # FRM101US.R2 03/09 08/08

SISEL International, LLC | P.O. Box 369 | Springville, Utah 84663 | Fax 801.409.8079 | Call Center 801.704.6700