Business Opportunities
Distributor Order Form

*Required Information



(*) Disclaimer
The applicant agrees and understands that Lexicon Marketing can trust the information provided at the time the distributor application form is submitted, and that any approval of such application and/or the effectiveness of any agreement between Lexicon and the applicant is conditioned solely on the fact that the application has been completed in its totality and in a truthful manner. The applicant agrees and understands that any omission or erroneous assertion of any fact or fundamental circumstance on the application will be considered by Lexicon a reason to reject such application and/or Lexicon may terminate any agreement in effect now or in the future between Lexicon and the applicant.

Applicant also agrees to immediately notify Lexicon Marketing in writing of any change in the facts or described circumstances noted in the application. Lack of notification to Lexicon Marketing of any essential change will be considered a material reason to reject such application and/or immediate termination by Lexicon without any responsibility of any type for the purpose of any agreement in effect now or in the future between Lexicon Marketing and the applicant.

Applicant certifies that all submitted information is exact and complete and agrees with all the terms and conditions stated previously.

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