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Consultant Enrollment Form
Filling out this form means you are joining the Pure Romance Romance Make It Happen Team based out of Milwaukee, WI, USA - if your consultant is not on our team - please contact her directly! Thank you!
Upon receipt of your enrollment form, your application will be sent to our VIP department within 24 hours.
*
Indicates required field
Your Legal Name
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First
Last
Your Preferred Name
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Address
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Line 1
Line 2
City
State
Zip Code
Country
*Kits can only be processed in the US and Canada.
Email
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Phone Number (xxx-xxx-xxxx)
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Date of Birth (MM/DD/YY)
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Have you ever Sold Pure Romance before?
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Yes
No
How long ago did you sell and under whom?
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Please complete. If you haven't sold Pure Romance before comment N/A.
What is the Name of the Consultant You are Working with Today?
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Select Your Kit
Select Your Starter Kit:
*
Premium Kit $659+ $19.95 s/h + Tax
Deluxe Kit $439+ $19.95 s/h + Tax
Standard Kit $219+ $19.95 s/h + Tax
SOCIAL SELLER $39 +Tax
Credit Card Number (xxxx-xxxx-xxxx-xxxx)
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Expiration Date (MM/YY)
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Security Code on Back
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Name on Credit Card
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First
Last
Billing Address (if Different from Above)
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Line 1
Line 2
City
State
Zip Code
Country
I have read and agree to the Consultant Agreement below:
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I agree
By clicking submit, you agree to send your enrollment form to our VIP deparment. Your card will be charged once it reaches our VIP dept within 24 to 48 business hours.
Submit
Consultant_Agreement.pdf
File Size:
167 kb
File Type:
pdf
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Our Team
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