Applicant Information (Apostrophes not allowed, omit or use a space)
*
 Required Fields on this form
This must be the name associated with the SSN# below. You may
not enter more than one person's name or a business name.
*
First Name
Last Name
*
REQUIRED. Social Security or Passport ID number - you will
need this when we call you for membership payment.
Company Name
OPTIONAL. You must enter the EIN# below.
MUST if entered a company name.
Please enter using the following format example: XX-XXXXXXX.
EIN
In order for the Corporation name and EIN# to take effect, we MUST have the following mailed or faxed
(859-422-7024) in to us: Fortune Business Entity Form (download from http://www.fhtmuniversity.com/
under "Tools" after becoming a representative), Certificate of Incorporation, partnership agreement or
trust documents and IRS letter of notice, assigning the entity's Employer Indentification Notice (EIN) or
referred to as the "Entity Documents". Please read the Policy and Procedures regarding Business
Entity's for further information.
Date Of Birth
Format: mm/dd/yyyy
*
REQUIRED. A valid drivers license number or any state issued ID will be
required when we call you for your membership payment.
*
Driver Lic #
*
Address
Address
2nd address line, if necessary
City
*
*
State
*
Zip Code
Check if Shipping Information is the same as Billing Information Above
*
First Name
*
 Last Name
*
 Address
Address
2nd address line, if necessary
*
City
State
*
*
Zip Code
Business Phone #
Format as 999-999-9999
Format as 999-999-9999
*
 Home Phone #
Format as 999-999-9999
Fax #
EMail Address
*
REQUIRED: New Applicant's email address
Alternate
EMail Address
New Applicant's alternate email address
*
 Select how your commissions should be paid to you
Commissions paid by
Required if selected Electronic Funds above
Account Type
*
(Required if Commissions are paid by Electronic Funds)
Account Type Route #
*
Account Type
*
 (Required if Commissions are paid by Electronic Funds)
A valid credit card will be requested for payment of your membership application fee  when we call you.
    Registration is 99.99 per year
Optional Bundle packs available.
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--------PLEASE DOUBLE CHECK ALL INFORMATION BEFORE SENDING APPLICATION----------