Flavon USA, LLC.

1370 North US 1, Suite 206,

Ormond Beach, Florida 32174

TIN: 45-4887162

Phone: [phone]

Toll free: [phone]

BUSINESS ENTITY INFORMATION FORM

Name of primary contact for entity: ....................................................................................................................................................................

E-mail of primary contact for entity: ...................................................................................................................................................................

SPONSOR INFORMATION • Sponsor’s name: ...................................................................... Sponsor’s IFC ID#: ................................

Please fill in the following sections with the information for all persons and/or entities with a beneficial interest in

this business entity. If more sections needed, attach a separate page to this form when submitting.

1)

Name: ...................................................................................................................... IFC ID#: ....................................................................

Position in the company: ...................................................... E-mail: ........................................................... Phone: .........................................

Signature:

....................................................................................................................... Date: ..........................................................................

2)

Name: ...................................................................................................................... IFC ID#: ....................................................................

Position in the company: ...................................................... E-mail: ........................................................... Phone: .........................................

Signature:

....................................................................................................................... Date: ..........................................................................

3)

Name: ...................................................................................................................... IFC ID#: ...................................................................

Position in the company: ...................................................... E-mail: ........................................................... Phone: .........................................

Signature:

....................................................................................................................... Date: ..........................................................................

4)

Name: ...................................................................................................................... IFC ID#: ....................................................................

Position in the company: ...................................................... E-mail: ........................................................... Phone: .........................................

Signature:

....................................................................................................................... Date: ..........................................................................

who hereby state that they have beneficial interest in the above mentioned business entity and their commissions deriving

from Flavon USA LLC will be invoiced through this company.

The following documents are also necessary when submitting this form:

•

Copy of Articles of incorporation, Partnership agreement, Trust documents or other legal

documents of the business entity

•

IRS letter assigning EIN of the business entity

Address: ..................................................................................................

Phone: .....................................................................................................

City, State, ZIP: ........................................................................................

E-mail: ......................................................................................................

Please complete this form in its entirety and return it to the mailing adress of Flavon USA, LLC.

Please review the most current version of the Independent Flavon Consultant (IFC) Agreement

and the Policies and Procedures of Flavon max Network before completing and submitting this

document.

Name of business entity: .....................................................................................................................................................................................

Type of entity: Corporation (LLC)

Partnership

Trust

E.I.N.: _ _ _ _ _ _ _ _ _

Signature of primary contact

Company seal

City, State, Date