Aim Global Application Form

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

www.allianceinmotion.com

DISTRIBUTOR APPLICATION FORM USER NAME

Personal Information LAST NAME

FIRST NAME

MIDDLE NAME

Address Birthdate MM Home Telephone No.

Age DD

Status

YYYY Mobile No.

E-mail Address Beneficiary

Age

Relationship

GLOBAL PACK SALES INFORMATION Sponsors Name

Sponsor ID No.

Placement Name

Placement ID No.

Position

L

R

Signature of Sponsor

Signature of Appllicant

PAYMENT INFORMATION Check

Cash

C24 / 7

Amount

Business Kit VCD Signature

For and behalf of

GLOBAL PACK PACKAGE

Date

Brochure

Endorsement Letter Scholarship

DAF

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

SINGLE X MARRIED SEPARATED DIVORCED