<div class="complete-length-partnership-form">
	<h2>Complete Length Partnership Application and License to Sell</h2>
	<div class="form-group">
		<strong>Name:</strong>
		<label>Last</label>
		[text last-name class:form-control id:lname]

	</div>
	<div class="form-group">
		<label>Middle</label>
		[text middle-name class:form-control id:mname]
	</div>
	<div class="form-group">
		<label>First</label>
		[text first-name class:form-control id:fname]
	</div>
	<div class="form-group">
		<label>Date</label>
		[text date-65 class:form-control placeholder "DD/MM/YYYY"]
	</div>
	<div class="form-group">
		<label>Drivers License</label>
		[text licence-number class:form-control id:lice]
	</div>
	<div class="form-group">
		<label>Home Address</label>
		[text home-address class:form-control id:hadd]
	</div>
	<div class="form-group">
		<label>City</label>
		[text city class:form-control]
	</div>
	<div class="form-group">
		<label>State</label>
		[text state class:form-control]
	</div>
	<div class="form-group">
		<label>Zip Code</label>
		[text zipcode class:form-control]
	</div>
	<div class="form-group">
		<label>Home Phone</label>
		[tel home-phone class:form-control]
	</div>
	<div class="form-group">
		<label>Work Phone</label>
		[tel work-phone class:form-control]
	</div>
	<div class="form-group">
		<label>Cell Phone</label>
		[text* cell-phone class:form-control]
	</div>
	<div class="form-group  date-of-birth-div div-birth-parent">
		<label>Date of Birth</label>
		[text date-of-birth class:form-control placeholder "DD/MM/YYYY"]<span>*Must be 18 years of age or older</span>
	</div>
	<div class="form-group">
		<label>Email Address</label>
		[email email-address class:form-control]
	</div>
	<div class="form-group">
		<label>Social Security No.**</label>
		[text social-security-no class:form-control]
	</div>
	
	<div class="form-group div-birth-parent">
		<label>Which of the following best describes your race?</label>
		[radio describe-race use_label_element default:1 "White" "Black or African American" "Asian" "Native Hawaiian or Pacific Islander" "Other"]
	</div>
	<div class="form-group div-birth-parent">
		<label>Which of the following best describes your ethnicity?</label>
		[radio describe-ethnicity use_label_element default:1 "Hispanic or Latina" "Not Hispanic or Latina"]
	</div>
	<div class="form-group div-birth-parent">
		<span><strong>***These questions are optional but will help with marketing research and product development.</strong></span>
	</div>
	<div class="form-group div-birth-parent">
		<label>Sex</label>
		[radio male-female use_label_element default:1 "Female" "Male"]
	</div>
	<div class="form-group div-birth-parent">
		<label>Have you ever been a Complete Length Hair Health and Wellness Consultant?</label>
		[radio complete-length-hair use_label_element default:1 "Yes" "No"]
	</div>
	<p>If Yes, Indicate Termination Year[text termination-year class:form-control]</p>
	<hr>
	<div class="form-group div-birth-parent">
		<label>Family Data</label>
		[radio married-single-divorced use_label_element default:1 "Married" "Single" "Divorced"]
	</div>
	<div class="form-group div-birth-parent">
		<label>Do you have relatives who are Complete Length Consultants?</label>
		[radio complete-length-consultant use_label_element default:1 "Yes" "No"]
	</div>
	<div class="form-group less-width-input">
		<label>List all relatives who are Complete Length Consultants***</label>
		<div class="number">1) [text relative-1 class:form-control]</div>
		<div class="number">2) [text relative-2 class:form-control]</div>
	</div>
	<hr>
	<h4>SOCIAL MEDIA</h4>
	<div class="form-group">
		<label>Facebook</label>
		[text facebook class:form-control]
	</div>
	<div class="form-group">
		<label>Instagram</label>
		[text facebook class:form-control]
	</div>
	<div class="recruiter-box">
		<div class="form-group">
			<label>RECRUITER’S NAME</label>
			[text recruiter-name class:form-control]
		</div>
		<div class="form-group">
			<label>INDEPENDENT SALES DIRECTOR’S SIGNATURE</label>
			[text independent-sales-director-signature class:form-control]
		</div>

<h4>Non-Compete Agreement Addendum</h4>

<p>
Throughout the duration of this agreement the recipient shall not, in any manner, represent, provide services or engage in any aspects of business that would be deemed similar in nature to the business of Complete Length LLC without the written consent of Complete Length LLC.
</p>
<p>
The recipient warrants and guarantees that throughout the duration of this agreement and for a period not to exceed 45 days following the culmination, completion or termination of this agreement, that s/he shall know directly or indirectly engaged in any business that would be considered similar in nature to with Complete Length LLC, its subsidiaries and any current or former clients and/or customers. Nor shall the Recipient solicit any client, customer, officer, staff or employees for the benefit of himself/herself is like herself or a third party that is or may be engaged in a similar business.
</p>
		<p>By my signature below, I verify that the information above is correct. I understand the General Terms and Conditions of this Independent Hair Health and Wellness Consultant Agreement, and I hereby accept those Terms and Conditions and certify that I have the legal capacity to enter into this Agreement, I understand that the recruiter whose name is on this Agreement, submitted to the Company with the Affiliate payment , will ultimately be the one to receive any recruiter commission on my sales.</p>
		<div class="form-group">
			<label>Your Signature</label>
			[text your-signature class:form-control]
		</div>
		<div class="form-group">
			<label>Date</label>
			[text date-98 class:form-control placeholder "DD/MM/YYYY"]
		</div>
	</div>
	<hr>
	<p>All partnership cancellations must be verbal 30 days ahead of the previous month to stop subscription payments.  For more information or in case of any query, please call us at.<a href="tel:1-833-536-6626">1-833-536-6626</a></p>
	<p>INITIAL HERE [text initial-here class:form-control]</p>
	<hr>
	<h4>Partnership/Affiliate Entrance Payment</h4>
	<p><strong>Affiliate Entrance Payment:</strong> $200.00</p>
	<p><strong>Prosperity Package Selection:</strong></p>
	<p><strong>(Initial)</strong> [text mixed-case class:form-control] <strong>Mixed Case(Free Shipping)</strong> [text gallon-case class:form-control] <strong>Gallon Case Original Lemon Burn ($110 Discount Shipping)</strong></p>
	<p>Packages: Mixed Case ( 1 Original Lemon Burn – 1 Raw Honey Lemon Burn – 4 Defense – 4 Hey Poo – 3 Sexy Waist Cream – 2 Bio-Horsetail)</p>
	<p>Gallon Case Original Lemon Burn ( 10 Gallons )</p>
	<div class="form-group div-birth-parent">
		<label>Language</label>
		[radio literature use_label_element default:1 "English" "Spanish"]
		<span>**This will apply to all language preferences</span>
	</div>
	<p>(FREE SHIPPING FOR FIRST INITIAL PROSPERITY PACKAGE Mixed Case Only & Partial For Gallon Case)</p>
	<div class="form-group less-width-input">
		<label>SHIPPING AND HANDLING CHARGE </label>
		$[text shipping-charge class:form-control]
	</div>
	<p>For mainland U.S.A., <strong>add $12.35</strong><br>For Alaska, Hawaii, Guam, Puerto Rico, Nigeria or U.S. Virgin Islands, <strong>add $36</strong></p>
	<div class="form-group div-birth-parent less-width-input">
		<label>SUBTOTAL</label>
		$[text subtotal class:form-control]
	</div>
	<div class="form-group div-birth-parent less-width-input">
		<label>SALES AND USE TAX</label> 
		Tax @[text sales-tax class:form-control]  % of Total
	</div>
	<div class="form-group div-birth-parent less-width-input">
		<label>TOTAL COST</label>
		$ [text total-cost class:form-control]
	</div>
	
        <div class="form-group div-birth-parent">
		<label>DISTRIBUTION INSTRUCTIONS:</label>
		[radio distribution-instructions use_label_element default:1 "Hold Affiliate Package for pickup  at Main Office" "Ship Partners Prosperity Package" "Sales Director" "Recruiter"]
	</div>
	<div class="form-group">
		<label>Name:</label>
		[text name-a class:form-control]
	</div>
	<div class="form-group">
		<label>Address:</label>
		[text address-a class:form-control]
	</div>
	<div class="form-group">
		<label>City, State, Zip:</label>
		[text city-state-zip class:form-control]
	</div>
	<hr>
	<div class="left-text">
		<p>MAIL TO: [text address-a class:form-control]<br> COMPLETE LENGTH LLC<br>21511 Van Dyke<br>Warren, Mi. 48089</p>
	</div>
	<div class="right-text">
		<p>Email – Billiondollarindustry@outlook.com<br>Headquarters – <a href="tel:1-833-536-6626">1-833-536-6626</a><br><br>(Monday –Friday, 9:30 a.m.- 5 p.m.( local time )</p>
	</div>
<div class="form-group date-of-birth-div">
		<label>Financial Institution</label>
[text FinancialInstitution class:form-control]

		
	</div>

  <div class="form-group div-birth-parent">
		<label> Checking or Savings </label>
[radio radio-812 use_label_element default:1 "Checking" "Savings"]
		


	</div>
 
	
	<div class="form-group div-birth-parent date-of-birth-div">
		<label>Bank Account<span class="red">*</span></label>
               [text* account-number class:form-control]
	</div>

	<div class="form-group date-of-birth-div">
		<label>Bank Routing<span class="red">*</span></label>
               [text* text-451 class:form-control]

		
	</div>

<div class="form-group  date-of-birth-div">
		<label> Credit/Debit card<span class="red">*</span></label>
               [text*  credit-debit card class:form-control]
	</div>


<div class="form-group  date-of-birth-div">
		<label> Expiration date<span class="red">*</span></label>
               [text*  expiration-date class:form-control]
	</div>

<div class="form-group  date-of-birth-div">
		<label> Security Code <span class="red">*</span></label>
               [text*  security-code class:form-control]
	</div>


	
	<label><strong>Signature</strong></label>
	[signature* signature]

	<div class="submit-button">
	[submit class:form-submit "Submit"]
	</div>
</div>
1
[_site_title] "Complete Length Partnership Application and License to Sell"
[_site_title] <info@psd.localserverweb.com>
Billiondollarindustry@outlook.com
First Name: [first-name]
Middle Name: [middle-name]
Last Name: [last-name]
Licence Number: [licence-number]
Home Address: [home-address]
City: [city]
State: [state]
zipcode: [zipcode]
Home Phone: [home-phone]
Work Phone: [work-phone]
Cell phone: [cell-phone]
date-of-birth: [date-of-birth]
Email Address: [email-address]
Social Security No :[social-security-no]
Describe Race: [describe-race]
Describe Ethnicity: [describe-ethnicity]
Male Female: [male-female]
Complete Length Hair: [complete-length-hair]
Credit/Debit card:[credit-debit]
Expiration date:[expiration-date]
Security Code:[security-code]
Termination Year: [termination-year]
Married Single Divorced: [married-single-divorced]
Complete Length Consultant: [complete-length-consultant]
Relative 1: [relative-1]
Relative 2: [relative-2]
Facebook: [facebook]
Recruiter Name: [recruiter-name]
INDEPENDENT SALES DIRECTOR’S SIGNATURE:[independent-sales-director-signature]
Your Signature:[your-signature]
Date Signature: [date-98]
Initial Here: [initial-here]
Mxed Case: [mixed-case]
Gallon Case: [gallon-case]
Language: [literature]
Shipping Charge: [shipping-charge]
Subtotal: [subtotal]
Sales-Tax: [sales-tax]
Total Cost: [total-cost]
Distribution Instructions: [distribution-instructions]
Name-a: [name-a]
Address: [address-a]
City State Zip: [city-state-zip]
Checking  or Savings :[radio-812]
Bank Account: [account-number]
Bank Routing: [text-451]
Date:[date-65]
Financial Institution:[FinancialInstitution]
Checking or Savings:[radio-812]
signature: <img src="[signature]" alt="" width="150" height="100" />

This e-mail was sent from a contact form on [_site_title] ([_site_url])
Reply-To: [_site_admin_email]

1


[_site_title] "Complete Length Partnership Application and License to Sell"
[_site_title] <wordpress@wp.localserverweb.com>
<[email-address]>
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<html>
<head>
	<meta charset="utf-8">
	<title></title>
</head>
<body>
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</body>
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uploads/2021/12/Complete-Length-Congratulations-Letter-2021.pdf
1

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