Enrollment Application

* = means required field

Your sponsor is

General Information
First Name: *
Last Name: *
Company:
Company Tax ID:
Enter a company Tax ID if you are operating your CieAura distributorship under a business name for 1099 tax reporting
If you are registering as a Business Entity, please fill out and submit the following form within 14 days of enrollment. We must have these forms on file for all Business Entities otherwise your 1099 will be issued in your personal name and SSN.
Address Line 1: *
Address Line 2:
Zip/Postal Code: *
City: *
State/Province:
or (Non-USA/Canada) *
Country: *
SSN/EIN/Tax ID:  
This is required for CieAura to issue a Payoneer Card to you for commission payments
 
My Shipping is the same as Billing:
Shipping Address Line 1: *
Shipping Address Line 2:
Shipping Zip/Postal Code: *
Shipping City: *
State/Province:
or (Non-USA/Canada) *
Country: United States *
 
Contact Information
Daytime Phone Number:
Mobile Number:
Fax Number:
Email Address:
Confirm Your Email Address:
Cell Phone For Receiving Text Messages:
I agree to receive occassional text messages to this number (standard rates will apply where applicable):
 
Your Login Account Information
Choose Your Username/
Store Name:
*
The username that your choose will also be your storename. For example if your username is USERNAME then your store name will be www.USERNAME.cieaura.com
Choose Your Password: *
Confirm Your Password: *
 
Referred By
Name of Referrer: