Individual Health Solutions, llc 8323 Sharon Dr., Suite 100 Urbana, MD 21704 Ph (301) 874-1797 Fax (301) 874-1798 info@signaturesupplements.com
Practitioner Registration Form				BioTyping Program
Business Name					SS# or Fed ID#
Your Last Name			First		Prefix
Address
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Phone Number			Back Line		Fax
Email Address
Web Page
Type of Practice					Years in Practice
Select one	Commission	I do not want to accept a commission
		I would like to received a 20% commission on all client purchases
Select one or none	Test Results	Email results to my office Email address above
		Results will be Email to the client
Notes
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Read the information below, once read and you agree, type "yes" in the appropriate box and submit form
Individual Health Solutions, llc Independent Associates Agreement (Practitioners)
This agreement is made on the date shown below by and between Individual Health Solutions, llc (IHS, llc) “Principal” and “Associate” described below: 1. Relationship: Principal grants to Associate the non exclusive right to provide tests to clients and forward orders for principal’s Signature Supplements™ nutritional program through their office. Associate is an independent contractor, not an employee of Principal for any purpose whatsoever. Principal shall not have the right to require Associate to undertake any actions that would jeopardize the Associate’s relationship as an independent contractor with Principal. All expense and disbursements incurred by Associate in connection with this agreement shall be borne wholly and completely by Associate. Associate does not have, nor shall they hold themselves out as having, any right, power or authority to create any contract or obligation, whether expressed or implied, on behalf of, in the name of, or binding upon Principal, unless Principal shall consent thereto in writing. 2. Policies and Procedures: The prices, charges, commissions and terms of sale of the products and services shall be determined by Principal. Associate can request to receive copies of test results and nutritional profile for each client ordering such program and assist in follow up testing. Client shall receive product directly from Principal. The Policies and Procedures shall be those currently in effect and established from time to time by Principal in its price books, bulletins, and other authorized releases. Changes in the Policies and Procedures shall be effective upon written notice. 3. Orders and Collections: Orders and tests initiated by Associate for Principals products and services shall be forwarded to Principal. Payment is to be made with each order by credit card and included with the completed IHS, llc test form. 4. Commissions: The commission schedule is shown as addendum A. Commissions are on product sales, net of shipping, sales tax, discounts, returns and allowances. Commissions shall continue for each client’s reorder introduced by Associate to program as long as Associate continues to add (3) new clients in a quarter of the calendar year. 5. Termination: This agreement shall continue in full force and effect until the date set forth in a notice given by one party to the other indicating such election to terminate this agreement. In the event of termination, commissions shall be paid to Associate only with respect to orders received by principal prior to the termination date. 6. Proprietary Rights: All the information not published for public distribution about the dietary supplements and the associated products and services supplied by Principal is considered propriety intellectual property. The Associate agrees to keep confidential any information disclosed or relative to the process or nature of the method or formula used for biochemical typing and or formulation. Said confidentiality shall survive the termination of this agreement. Associate further agrees not to sell or participate in any form whatsoever as a sales agent, associate or manufacturer of a similar product using personal biochemical information to determine the formulation or ingredients of dietary supplements and related products or services, for a period of three years after termination of this agreement. 7. Trade names & Trademarks: Associate shall not use the Principal’s trade names or trademarks in any way other than in the advertising, educational and sales materials made available to Associate or approved by Principal in writing. 8. Assignment: Associate shall not directly or indirectly assign or otherwise transfer any such rights and or obligation under this agreement in whole or part without prior written consent of Principal, and any such assignment or other transfer without such consent shall be void. Principal at any time or from time to time, may assign or other wise transfer any or all of it’s right’s and or obligations under this agreement to one or more assignees or transferees of it’s choosing, and the associate hereby consents and agrees to be bound by any such assignment or transfer. 9. Agreement: This agreement supercedes all other Agreements between Principal and Associate. It shall be determined in accordance with the laws of the state of Maryland. In the event any provision herein is determined to be invalid or unenforceable by arbitration or a court of competent jurisdiction, the remaining provisions shall remain in full force and effect. Each party represents and warrants that it is duly authorized to execute and carry out the provisions of this Agreement.
Individual Health Solutions, llc Associate Agreement - Practitioner Addendum A
1. Relationship: Associate is an independent contractor initiating this program through their office to their patients. 2. Commissions: If you elect to receive the 20% commissions then this commission will be paid monthly on products shipped during the preceding calendar month. The practitioner’s client pays Principal for full amount of program including first shipment of products at time of completion of the assessment test. They are automatically enrolled in an auto ship program that can be canceled at any time by client. 3. Assessment form: The evaluation form is a proprietary document supplied by Principle and used by Principle’s exclusive Nutritional Program to determine an individuals self administered biochemical profile – Biotype™. Such information is used to determine an appropriate selection of personalized dietary supplements and an individualized nutritional program. 4. Pricing: $119.43 to $129.57 plus $6.00 shipping and handling for a bottle of 240 capsules of formula. $19.95 for scoring test and providing test results and individualized nutritional profile via Email. 5. Follow up research: All clients using program shall be called on by phone, mail or email to take a follow up test from time to time to determine the benefits and any side effects of taking the supplements. Information and results shall be held confidentially and safeguarded by the Principle. Only total aggregated results will be made public at the discretion of the Principle. 6. Sales Tax: All purchases for product originate in the state of Maryland which presently has no sales tax on the purchase of supplements. 7. Other taxes: All associates are independent contractors and shall receive an IRS 1099 tax form mailed out on the 30th day of January following the end of the year for taxable income received. 8. Product claims: Only product claims stated in official Principal literature, web site and training materials are allowed. 9. Guarantee: Client has an option to return initial product within 60 days of our shipping date for full refund of the cost of product – Assessment cost and shipping is not refundable.
Type "yes" in the box below if you agree to the above terms and conditions.