Black Hills Health Products
Member Application and Agreement Form

7216 Lola Dr.  Black Hawk, SD  57718***Now under new Ownership & Management ***(formerly known as : FMG/The Health Nuts)
(605) 787-6253
Local Home Office Number  Hours 8:00am to 5:00 pm Mountain time M-F 1-(888)-383-4056 Toll Free Number
(605) 787-6267 Fax Number

New Member SS # or Fed ID #
(office use)
Sponsor Name:
Sponsors BHHPI #
Sponsor's Phone #
Check one: Individual DBA Corporation
Trust Other
Call your Sponsor if you need assistance with this form!
Applicant's Name (Last, First, Middle Initial)
Date of Application
Payment Method Billing Address:
Street Address
City State Zip Code
Permanent Shipping Address (if different from above:)
Street Address
Zip Code
Home Phone
Cell Phone
Work Phone
E-Mail Address
Please select ONE of the following options, and consult your sponsor for assistance to be sure you understand your choices:
OPTION 1: Auto-Purchase and Auto-Payment
As a convenience to me, I instruct and authorize Black Hills Health Products, Inc. to send me future
product purchases each month, around the 15th, the following product(s) ________________________
__________________________________________________________________________________, which will qualify me for any commissions earned. Please
Please deduct my Auto ship purchase(s) + shipping and handling from one of the following payment methods. 

  Charge my credit card to purchase products for the next month, ACCT.#______________________ exp.________

  Draft my bank account to purchase products for the next month, ACCT.#__________________________ Routing#.__________________________
It is my responsibility to notify the home office of any updates or changes to this information!

Completed STANDING ORDER must be submitted with this application!
OPTION 2: Manual Purchase
I understand I will be responsible for ordering and paying for all my products each I place an order.
Please send me all my commissions I may have earned, if I was qualified. I understand I will not receive a commission check if I fail to make a qualifying purchase in the same month I have down line ordering in.
Applicant signature (required)
I hereby apply to become a member of Black Hills Health Products, Inc.. I have read and understand the terms and agreements. I have read and understand the Policy and Procedures. I have read and understand the compensation plan.
By signing below, I certify that I am of legal age in the state I reside. I understand I have the right to terminate, with or without reason, by submitting written notice to Black Hills Health Products, Inc. home office. Membership is automatic pursuant to my 1st purchase of products payable by VISA, MasterCard, Discover, or American Express Credit cards, personal/business check, cashier's check, money order,  bank draft. or cash.
Applicant signature (required)
This form must be filled out, signed & returned by fax or mail to our home office!

 WelcomeCompany Information

Colon Health   Colostrum  Mineral Water  Acid Wastes  One of a Kind Anti-Oxidant

Enzymes Q&A  Oatmeal Test

Testimonials  Comp Plan  Application and Agreement

Products Tinctures in a Bottle

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Black Hills Health Products

7216 Lola Dr.
Black Hawk, SD  57718
Toll free (888) 383-4056
Office(605) 787-6253
 Fax (605) 787-6267

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