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Business Entity Registration Form

Business and Shipping Information

Please Print Legibly Federal Tax ID (Required)
Business Name:______________________________________________________
CONTACT NAME: (First, MI, Last) __________________________________________________________________
TYPE OF BUSINESS (Example: Corporation, LLC...)_____________________________________________________
MAILING ADDRESS: ____________________________________________________ APT/SUITE #: ________
CITY: ________________________________ STATE: _______ ZIP: ____________ COUNTRY: ___________
PHONE: (Daytime) ________________________ PHONE: (Cell) _____________________ PHONE: (Home) ___________________
FAX: _________________________________ EMAIL: ______________________________________________

Partners, Members, Managers, Shareholders, Officers, Directors or Trustees

Identify All Partners, Members, Managers, Shareholders, Officers, Directors, Trustees or Other Participants. Attach additional pages as necessary.

NAME and TITLE (Please Print Legibly)_____________________________________________________________

Address___________________________________________________ SS Number ____________________
____________________________________________________________ Signature ___________________

NAME and TITLE (Please Print Legibly)_____________________________________________________________

Address___________________________________________________ SS Number ___________________
____________________________________________________________ Signature ___________________

NAME and TITLE (Please Print Legibly)_____________________________________________________________

Address___________________________________________________ SS Number ____________________
____________________________________________________________ Signature ____________________

The above signatories (and others as may be appended to this document) certify that each is authorized to sign any document necessary to conduct
business with Syntek Global, and is liable for all contracts entered into with Syntek Global jointly and severally. Each acknowledges that they are
individually bound to and must comply with the terms and conditions of the Syntek Global Distributor Agreement and Policies and Procedures.
Violation of the Syntek Global Distributor Agreement and/or Policies and Procedures by any partner, member, shareholder, employee, trustee, or
other individual associated with the ownership or management of the Entity applicant shall be jointly and severally imputed to the entity and all
other owners, partners, shareholders, trustees, managers, members or persons with other ownership or managerial responsibility for the entity.
Failure to list all appropriate persons on this Business Entity Registration form shall be grounds for disciplinary sanctions as described in the
Policies and Procedures. Any individual or entity having an ownership interest or management position with the business entity may not have any
interest, legal, equitable, ownership, management, or otherwise, in any other Syntek Global Distributor business. Transfers of ownership interests
in Distributor’s business by an entity are subject to the Syntek Global Policies and Procedures. See the Policies & Procedures for a description of the
Transfer Policy. This form, together with copies of the entity documents described in Section 4.4 of the Syntek Global Policies and Procedures,
must be sent to Syntek Global within 30 days of the entity’s enrollment as a Syntek Global Independent Distributor. If this form and the entity
documents are not timely received by Syntek Global, the Distributor Agreement of the subject entity shall automatically terminate.

Effective May 21, 2009 1