License and Account Information For new Winslow Consultants *The information below will be used to establish your new Winslow Consultant account.Name(Required) First Last Company Name(Required) Company Name Date(Required) Month Day Year Address(Required) Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Mobile Phone(Required)Office Phone(Required)Email(Required) MARKETING AND EMAIL:I would like an affiliate marketing site at www.winslowsolutions.com ( Learn more about affiliate marketing sites)Affiliate Site Yes I would like to obtain a @winslowsolutions.com email account (free of charge)Winslow Email Yes If yes, review and sign the Terms and ConditionsADDENDUM A- CONSULTANT LICENSE FEE:License Purchase or Transfer?(Required) Purchase Transfer License Purchase(Required) Business Consultant - $3,500 License Fee incl. 5 profiles Senior Consultant - $12,500 License Fee incl. 10 profiles Executive Consultant - $35,000 License Fee incl. 20 profiles License Transfer(Required) Business Consultant - $1,500 Transfer Fee Senior Consultant - $5,000 Transfer Fee Executive Consultant - $14,000 Transfer Fee For purchase of this license, we ask that you remit payment via wire transfer. Please disregard filling out this form, and contact us by emailing eric@winslowsolutions.comADDENDUM A- ENROLLMENT LEVEL FEE:Enrollment Level(Required) Basic (included) Premium (paid) Enrollment Fee(Required) Premium (Monthly) $79.00 Premium (Annual) $799.00 Enrollment Fee(Required) Premium (Monthly) $79.00 Premium (Annual) $799.00 Enrollment Fee(Required) Premium (Monthly) $49.00 Premium (Annual) $499.00 Enrollment Fee(Required) Premium (Monthly) $49.00 Premium (Annual) $499.00 Enrollment Fee(Required) Premium (Monthly) $29.00 Premium (Annual) $299.00 Enrollment Fee(Required) Premium (Monthly) $29.00 Premium (Annual) $299.00 ADDENDUM D- CUSTOM BRANDING OPTIONS:Branding Options None Silver Gold Please email eric@winslowsolutions.com to discuss custom branding in further detail.------------Total TERMS AND CONDITIONS:Consent(Required) I understand I am remitting a one-time Consultant License (or transfer) fee, in addition to any recurring payment options I may have selected. I understand I may be required to attend retraining at the prevailing costs if I have not reached certain production levels by 24 months from today.(Required)*When you click "Submit" below, you will be redirected to our payment processing system in order to complete your payment.
