Authorization to Operate Account

2 Corporate Park, Irvine, CA 92606 (949) 789-2000 FAX (888) 564-5536 www.nikken.com

CONSULTANT ID # ______________________________________________________________________________________

PRIMARY APPLICANT____________________________________________________________________________________

CO- APPLICANT_________________________________________________________________________________________

I/We authorize, ___________________________________________, (not a Nikken Consultant) to access and place orders on
my/our distributorship account.

I/We understand that this authorization will remain in effect until I/We revoke this authorization in writing. I/We further
understand that I/we are fully responsible for any action by the individual I/we authorized to operate my/our account and his/her
action will be attributed to me/us, subjecting my/our distributorship to any disciplinary action. I/we will make my/our best
efforts to ensure that the authorized individual is aware of Nikkens Policies and Procedures.

Primary Applicant: Signature*________________________________________________________ Date: ________________

Co- Applicant: Signature*____________________________________________________________ Date: ________________

* All applicants listed on the distributorship account must sign.

Acknowledgment
STATE OF: _____________________________________________________________________________________________

COUNTY OF: ___________________________________________________________________________________________

On ________, ____________________, 20______, before me ___________________________________________________,

Day

Month

Name of Officer

Notary Public, personally appeared _________________________________________________________________________,

who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument
and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s), or entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.

Signature _______________________________________________________ (Seal)

My commission expires ____________________________________________.

Date
10/14