AIM Direct Customer Application

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Barleygreen: Superfortified Whole Food

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Use this application to become an AIM DIRECT CUSTOMER IF

*You have been in contact with an AIM Member or you have an AIM sponsor.

Available in Canada and the United States only

All areas in bold are required information.

First Name:-----------------------------------

Last Name:------------------------------------

Address:--------------------------------------

City:-----------------------------------------

State or Province:----------------------------

Zip or Postal Code:---------------------------

E-mail:

*Member's------------------------------------

*Direct Customer's --------------------------


Member's last name:---------------------------

Member's AIM ID: -----------


Sign Here:------------------------------------

SUBMIT TO: angelprincessjo@yahoo.com