HSIN TEN ENTERPRISE USA, INC.                                                                                                          380 Smith Street, Farmingdale, NY 11735                                                                                                                  Tel:  1-631-454-1600  Fax:  1-631-454-1601

Total Health Spa Installment Program - USA  Application Form

I would like to enroll in HTE's Total Health Spa Installment Program.  I have reviewed the terms and conditions below and I agree to abide by the terms and conditions stated in this document.

Name:______________________   Phone # (____)______________   Fax # (____)_________________

Distributor Name:       Vernon Spicer        Distributor #A126139          Phone #(214) 724-2468            

Credit Card Information:         Type:    ___Master Card      ___Visa        ___AMEX         ___Discover  

Credit Card #________________________________                      Expiration Date__________

Card Holder's Name_____________________________             e-mail__________________________

Address______________________________   City______________  State__________  Zip__________

County____________________   Phone # (____)________________   FAX #(_____)________________

Signature______________________________________________________________________________

Instructions:  Complete this Application Form and return via FAX to HTE for processing        (800-547-1508).  The applicant will be notified of his/her acceptance into this program within 3 days.

Guidelines:

I agree to pay a $20.00 Application Fee and allow HTE to charge the credit card above for this amount.                             

This program is available to all Distributors and/or Distributor's Customers in the U.S.A. with minimum FICO credit      score of 600.                                                                                                                                                                                                       

All BVP's will be awarded the month the initial down payment is made.  Commissions will be paid out at a percentage rate proportionately equal to the percentage rate of payments.                                                                                                             

All  purchasers of The Total Health Spa (1 Chi Machine and 3 HotHouses) will be immediately promoted to Supervisor Club level upon completion of their Distributor Application.  Supervisor status will revert to Distributor status if customer makes a partial return of  products.                                                                                                                                                                

Payment methods are by credit card (Visa,  Master Card,  Discover, or American Express).                                                       

Credit Card deductions for Installment payments will be made on the 20th of each month.  For months in which the 20th falls on the weekend, credit card deductions will be made the following Monday.                                                            

Any customer making partial return will be required to pay the remaining balance in full,  Example:  A customer who decides to return one HotHouse will no longer be able to pay through installments and must immediately pay the remaining balance on the other two items (2 Hothouses and 1 Chi Machine).                                                                                                          

Returns made on Total Health Spas within the 14 day trial period will be refunded upon HTE's receipt of items.                    

If there is a return, all promotional items must be included or the original price of the item(s) will be deducted from the amount of the refund.                                                                                                                                                                           

Special Bonus award of $150.00 (USD) when participating in the SOQ-618 incentive program will be distributed after full payment is made.                                                                                                                                                                                                  

Limited to one Installment Plan per individual.                                                                                                                                      

HTE reserves the right to amend or change the terms and conditions of the program at any time, without prior notice.

Installment Plan Options (Select One)
____Option A:

Six Monthly Payments with 0% Interest

* 30% Down payment = $953.00 + full sales tax on $3,177.00 (calculated according to local sales tax rate).

* Five (5) subsequent payments of $444.80

____Option B:

12 Monthly Payments with 8,81% Interest

* 30% Down Payment = $953.00 + full  sales tax on $3,177.00 (calculated according to your  local sales tax rate).

* Eleven (11) subsequent payments of $220.00

 

Applicant's Signature_________________________________   Date_______________________

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HSIN TEN ENTERPRISE USA, INC.              TOTAL HEALTH SPA INSTALLMENT PROGRAM

USA  Application Form

Please print all information clearly.  Read, sign, and date this application and FAX both pages to:  800-547-1508

Personal Information

Applicant's Name___________________________________________ Birth date:________/_____/______                                         (First)               (Middle)                        (Last)                              (Optional)      (Month)            (Date)     (Year)

Drivers License Number:_________________ State_________  Soc.Sec. #.:______/____/________

 

 

Residence Information

                       Current Address:

 _________________________________________________________________________________   (Street Address)                             (City)                                                (State)                                  (Zip)                                 (Apt. #)

 

 

Employment Information

Current Employer Name:____________________________ Employer Phone: (____)____-______

Employer's Address:

 _____________________________________________________________________________                               (Street)                                  (City)                                     (State)                                  (Zip)                  (Suite #)

 

Position _______________________________  Annual Income  $_________     Phone (____)______-________ 

 

I hereby authorize general Data Services to use any consumer reporting agency, credit bureau, or investigative agency to confirm the information contained herein, pertaining to my employment, credit history, prior tenancies, character - and to obtain a credit report and verify bank references and disclose such information to the owner/agent or representative in support of this application.  I have completed this application and recognize that the truth of the information contained herein is essential.

  ______________________________________________________________________________________ Applicant's Signature                                                                                                                           Date

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