La Diva Beauty, LLC

Promoter Application

First Name ____________________

Middle Initial (optional) ___________________

Last name ________________________

Birth Date (mm/dd/yyyy) _______________

Email Address _______________________

Mobile Number ______________________

Address _______________________

                _______________________

                _______________________

Social Security # ______________________(*)

Or

EIN ____________________________

Company Name ______________________

I acknowledge that I have read and agree to:

• La Diva Promoter Agreement Terms and Conditions
• La Diva Promoter Policies and Procedures
• La Diva Internet Advertising Social Media Policies and Procedures
• La Diva Commission Plan

Yes______                           No___________

Were you referred by a current La Diva Promoter?   Yes_____  No______

If Yes, name and email address ______________________________

Signature _________________________ Date _________________________

(*) If social security number not provided, any payments earned under the commission plan will be withheld until valid social security number is received