Medico Franchise Application Form

ONLY APPLICABLE IF IT'S MORE THEN ONE PARTNER.

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

REFERENCES

COMPANY NAME

CONTACT NAME

Phone Number

Area CodePhone Number

OTHER BACKGROUND INFORMATION

Have you or any applicable partners, officers, directors, or shareholders with your business affiliations ever:

Had any administrative, criminal or civil action alleging a violation of any franchise law, fraud, embezzlement, fraudulent conversation, restraint of trade, unfair or deceptive practices, and misappropriation of property or comparable allegations?

YESNO

Been convicted of a felony or pleaded “no contest” to a felony charge or been held liable in a civil action by a final judgement or been the subject of a material complaint or other legal proceeding such as a felony, civil action complaint, misappropriation of property or comparable allegations?

YESNO

Been adjudged bankrupt or reorganized due to insolvency?

YESNO

If you answered “Yes” to any of the questions above, please explain:

GENERAL INQUIRY

ARE YOU PREPARE TO COMPLY WITH THE PROCEDURES AND CONTROLS SET BY THE COMPANY?

YESNO

Why do you think you will be successful?

Are your intentions to work full time in the business?

YESNO

Are you aware certain information provided and/or advised to you is confidential and shall not be divulged to any third person?

YESNO

I certify that my answers are true and complete to the best of my knowledge. If this application leads to Partnership, I understand that false or misleading information in my application or interview may result in my release.

Date of signing*

Date

APPLICANT 1 Signature *

APPLICANT 2 Signature

PRICE LIST

SEMAGLUTIDE 4MG PEN $90 MOQ 10

SEMAGLUTIDE 8MG PEN $120 MOQ 10

B12 2ML VIALS COMES 10 PER BOX $35 MOQ 10

FAT DISSOLVER 1 BOX OF 10, 10ML VIALS $200 MOQ 2

APPETITE SUPPRESSANT $25 MOQ 10

FAT BURNER $25 MOQ 10

MEDICO 50 BAGS 5X9 =$90

MEDICO 50 BAGS 7X5 BAGS $100

IF YOU WANT CUSTOM BAGS PLEASE LET US KNOW.

1 PACK RX FORMS FOR INSIDE SEMAGLUTIDE CASES =$100

My Products

Medico RESELLER Application Form

Inventory Request