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1. Organo Gold International, Inc.
5505 Hovander Rd. Ferndale, WA 98248
NonProfit / Health Care Practitioner Free Signup USA Representative
MUST be Accompanied by an Initial Order OGF_10-013
Appli- (*) Mandatory
* Social Security # * First Name Middle Initial * Last Name
Billing Address * Number and Street Shipping Address * Number and Street
Address Line 2 (Suite or Apartment no.) Address Line 2 (Suite or Apartment no.)
* City * State * Zip Code * Country * City * State * Zip Code * Country
* Daytime Phone Evening Phone Fax Number * Daytime Phone * Email address:
Organization Information
* Tax ID # * Organization Name * Contact Phone
* Enrolling Sponsor * Placement (Select one)
* Sponsor’s 10000259706 * Sponsor’s Yamilette Williams Left Right
OG ID #
Order Autoship Item UNIT
Qty Qty Description PAYMENT
COST
(501) OG Gourmet Black $17.00
(502) OG Gourmet Mocha $20.00
(503) OG Gourmet Latte $17.00
(504) OG Gourmet Hot Chocolate $20.00 Visa MasterCard AMEX
(505) OG Organic Green Tea $22.00
(507) OG Café Supreme $22.00 Credit Card Number
(508) OG Royal Brewed $34.00
(801) OG Organic Ganoderma $41.00
(802) OG Pure Mycelium $41.00
(803) OG Organic Ganoderma Spores $66.00 Exp Month Exp Year CCV
(804) OG Grapeseed Oil Extract $41.00
(905)OG G3 Soap 3 Pack $24.00
(907) OG Smile Sampler (10 small tubes x 30g each) $37.00
(908) OG Smile (1 large tube x 150g each) $14.00 Card Holder Name
(106) OG 3 Pack (1 black,1 mocha 1 latte) $54.00
(107) OG 6 Pack (2 black 2 mocha 2 latte) $108.00
(306) OG 5 Pack (1 black 1 mocha 1 latte 1 hot chocolate 1 green tea) $96.00
(800) OG Capsule Pack (1 ganoderma 1 mycelium 1 spores 1 grapeseed) $189.00 Note: All Orders Will Be Charged Applicable
Taxes, Shipping and Handling
FREE SHIPPING CASES
AUTO-SHIP DATE
(112) OG Variety Case (6 black 6 mocha 6 latte 6 hot chocolate 6 green tea) $576.00 (If Applicable)
(113) OG Green Tea Case (30 boxes) $660.00
(114) OG Hot Chocolate Case (30 boxes) $600.00 Shipped the
(115) OG Black Case (30 boxes) $510.00 NONE
1st 15th
(116) OG Mocha Case (30 boxes) $600.00
(117) OG Latte (30 boxes) $510.00 of the following month
(118) OG Combo Case 1 (10 black 10 mocha 10 latte) $540.00
(119) OG Combo Case 2 (15 black 15 latte) $510.00
Fax to 1-604-288-5488 or
FREE SHIPPING FOR CASES and For Orders 500 PV above (Prices are in USD)
Email to: support@Organogold.com
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 Co-Applicant’s
Date Date
Signature Signature

2. Organo Gold International, Inc.
5505 Hovander Rd. Ferndale, WA 98248
NonProfit / Health Care Practitioner Free Signup USA Representative
MUST be Accompanied by an Initial Order
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 16. In sponsoring other Representatives, I agree to fulfill the obligations of
understand the Terms and Conditions contained herewith along with the Statement of performing a bona fide supervisory function in the sales and distribution of product to
Policies & Procedures, which by reference are fully incorporated in this document, the ultimate consumer and in the training of those Representatives I sponsor. I will
and agree to be bound by them. I/we also understand that I/we may terminate my/our maintain ongoing contact, communication and management supervision in my sales
Independent Organo Gold Representative status at any time with written notice to organization. Examples of this supervision may include but are not limited to,
Organo Gold. I understand that it is my responsibility to ensure that product sales, as newsletters, written correspondence, personal meetings, telephone contact, voice mail,
well as payment for such sales, are processed prior to the end of a commission period electronic mail, training sessions, accompanying individuals to company trainings,
to be eligible for a commission. proper use of compensation summaries regarding earnings representations and sharing
1. First and foremost, Organo Gold International Inc. is built on a foundation of distribution information with those sponsored. I will be able to provide evidence to
integrity, edification and trust. Whether dealing with my customers, fellow the company semiannually of my ongoing fulfillment of these responsibilities.
Representatives or the Company, I will build my business on this same foundation. If 17. I understand that Organo Gold’s program is built upon retail sales to the ultimate
anything comes to my attention that detracts from this, I will deal with it immediately, consumer. I am entitled to purchase product for my own personal or family use, and I
first through my upline organization, then to the Company if necessary. I will not understand that Organo Gold policy prohibits the purchase of product or large
allow any attempt to destroy the foundation; disparagement toward my fellow quantities of inventory solely for the purpose of qualifying for bonuses or
Representatives or Organo Gold in any form will not be tolerated. advancement in the marketing program. Likewise, I will not encourage others in the
2. I certify that I am at least 18 years of age (or age of majority) and understand the program to purchase excessive inventory. I understand that I must fulfill published
Agreement is not binding until received and accepted by Organo Gold. personal and downline sales requirements as well as supervisory responsibilities to
3. I agree to operate my business in accordance with all the rules, regulations, policies qualify for the bonus overrides and advancements.
and procedures as set forth by Organo Gold in its Statement of Policy & Procedure 18. In the event that I wish to terminate my Independent Representative status, I may
(SOPP), a copy of which is available in my back office, and in any amendments, return any unused, unopened, and resalable products purchased within 60 days of the
supplements, or replacements in the future. invoice date for refund, and will receive the invoiced amount, less a 10% restocking
4. I will become an Independent Contractor (Representative) upon acceptance of this fee and appropriate set-offs for bonuses, rebates, commissions, and other charges. "60
application by Organo Gold. As an Representative, I shall have the right to sell the days" becomes "90 days" in MD and PR, and becomes "one year" in GA, IA, LA,
products and services in accordance with Organo Gold’s compensation plan. MA, MT, OK, TX, and WY and any additional requirements of the buy-back laws of
5. I understand that I will be responsible for obtaining all necessary licenses and the mentioned jurisdictions will be honored. Additionally, Montana Independent
permits and for complying with all applicable federal, state and/or municipal laws, Representatives who cancel within 15 days are entitled to a 100% refund of any
codes and regulations in connection with my activities as an Organo Gold consideration given to participate. Beyond the two dates, I understand that Organo
Representative. I acknowledge that I am not an employee of Organo Gold and shall Gold will not accept any returns for product.
not be entitled to receive from Organo Gold any benefits whatsoever and Organo 19. On a periodic basis, Organo Gold may supply confidential information in the form
Gold shall not be required to make contributions for FICA, workers compensation and of genealogies, reports, and other sensitive material, which will provide information
other similar levies in respect of payments to be made to me as a Organo Gold to me as an independent Representative concerning my organization. I agree upon
Representative. I will be fully responsible for paying all applicable federal or state receipt of said information that such information is proprietary and confidential and
withholding taxes, source deductions, taxes, employment insurance premiums, will not disclose such information to any third party directly or indirectly nor use the
workman’s compensation contributions or other tax contributions and other information to compete with Organo Gold either directly or indirectly.
premiums, license requirements and fees related to my activities as a Organo Gold 20. I understand and agree to remit any Sales Tax based on the retail price of the
Representative. product to the company on all product orders unless tax exempt.
6. I acknowledge that as a wholly independent Representative, I am not purchasing a 21. I agree that I may not alter, repackage, re-label, affix additional labels of
franchise or exclusive distributorship, and no fees are or will be required from me for information or otherwise change any Company product, nor will I sell any such
the right to distribute Organo Gold’s products pursuant to this agreement, with the product under any other name.
exception of $49.95 OG Business Kit, which is non-commissionable, and provided a 22. I understand and agree that all claims and disputes relating to this Agreement, the
company cost. I acknowledge that this agreement may not be assigned or transferred right and obligation of the parties or any other claims or causes of actions relating to
without written consent from Organo Gold. the performance of either party under this Agreement and/or purchase of products or
7. As a Representative I will abide by any and all Federal, state and local laws, rules services shall be settled by binding arbitration in the City of Ferndale, Washington, in
and regulations pertaining to this Agreement and/or the acquisition, receipt, holding, accordance with the Commercial rules of the American Arbitration Association.
selling, distribution, or advertising of Company products. Jurisdiction and venue shall be Ferndale, Washington. Each party having a concern
8. As a Representative I will, at my own expense make, execute or file all reports and shall first give notice of the offense and allow at least thirty (30) days for the other
obtain licenses required by law or public authority with respect to this Agreement party to cure. In the event of a dispute, the prevailing party shall be reimbursed its
and/or the receipt, holding, selling, distributing of Organo Gold Products. costs and attorney's fees. Louisiana residents may choose jurisdiction and venue in
9. I will be solely responsible for declaration and payment of all local, state, and New Orleans, Louisiana.
Federal taxes as may accrue because of my independent business activities in 23. I agree that regardless of the form of claim, whether in tort, contract or other, the
connection with this Agreement. I acknowledge that Organo Gold reports all my Company, its subsidiaries and affiliated companies and their officers, directors,
commissions, rebates, and bonuses to the appropriate regulatory agencies in the employees and agents shall NOT be liable for any consequential, incidental, special,
United States, as required by law. or punitive damages, including lost profits or any other claims against the Company.
10. I understand that this Agreement shall automatically renew annually provided that No legal action maybe brought by either party to this Agreement more than one year
I have maintained active status as an Representative by generating a minimum of 50 after the event giving rise to the cause of action has occurred.
PV (point value) in a rolling five week period including the current week. Organo 24. I certify the accuracy of all information provided by me in this Agreement and
Gold has my permission to charge the credit card on record the current renewal fee on agree that the providing of false or misleading information authorizes the Company,
or before my anniversary date unless I cancel my Representative status in writing to at its election, to declare this Agreement void from its inception.
the Company.. 25. I will make no claims of therapeutic or curative properties regarding the Company
11. I further understand that all rights to bonuses, rebates and commissions; my products or claims involving the Organo Gold Compensation Plan that are NOT
Organo Gold business; and the opportunity to purchase products from Organo Gold contained in official Company literature that is produced and distributed by the
shall immediately be subject to termination should my status become inactive. Company. Sponsors are compensated for the sale of Products and those Products sold
12. I understand that I am entitled to cancel participation in the marketing program at through their ales organization. No OG Representative will ever be compensated for
any time and for any reason upon written notice to Organo Gold. Following the sponsoring. Without question, the sale of products to end consumers is the basis of the
notification of cancellation or termination, the sponsoring Representative or Organo Company’s program and must be emphasized in all presentations. Representatives
Gold will repurchase inventory and mandatory starter kit materials in accordance with may not make any claims as to any therapeutic or curative properties of the
the policies as stated in Organo Gold’s Statement of Policy. Company’s products. The Company’s products are not intended to diagnose, treat,
13. I certify that neither Organo Gold nor my sponsor have made any claims of cure, Prevent, or mitigate any disease and should never be offered as such.
guaranteed earnings or representations of anticipated earnings that might result from Representatives shall not suggest any diagnosis, prognosis, evaluation, treatment,
my efforts. I understand that I may not make any verbal or written statements description, management or remedy of illness, ailment or disease. Representatives
regarding claims of income or potential earnings that might result from my efforts or may not make any false, unreasonable, misleading, or intentionally misrepresenting
the efforts of others, unless specifically disclosed in a compensation summary income projections to prospective or current Representatives. Under no circumstances
provided from time to time by the Company. may OG Representatives recruit other OG Representatives for other Business
14. I understand that no attorney general or other regulatory authority reviews, Opportunities. The Company reserves the right to Accept or Reject any applicant and
endorses, or approves any product, membership, compensation program, or company, is under no obligation to offer any reason for rejection. If an Application is submitted
and I will make no such claims to others. In the event a question shall arise through the Internet will be Considered an original application. Incomplete
concerning legal compliance by Organo Gold, such questions shall be submitted to applications will not be accepted and are the sole responsibility of the Applicant. The
Organo Gold in writing. Company is under no obligation to notify an applicant of an incomplete or faulty
15. I agree to indemnify and to hold Organo Gold blameless from any and all claims, application.
damages, and expenses, including attorney fees, arising out of my actions and conduct
in violation of this Agreement.