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Jennifer & Charles Livesay | 6655 East 18Th St | Indianapolis IN 46219 | E-mail jennifer.livesay@conklinIBO.com
 

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Customer Package Enrollment and Independent Business Owner (IBO) Application Form

* Buy Conklin® Products at Discount
Whether you want to just buy product at discount or become a distributor (IBO), you must choose a Customer Package.
Please note: The data in this form cannot be saved between sessions. That means you must complete it all at once; it can take up to 20 minutes to do the whole form, if you include the IBO application.

Preferred Customer

 Package Features and Cost
  • One-time $25 membership fee
  • 20% discount from suggested retail prices
  • Purchase from all product lines
  • $50 initial minimum order in the first 30 days
  • Product Order Form.

Wholesale Customer (choose one below)

 Package Features and Cost
  • Membership fee included
  • 40% discount from retail prices
  • $150 - $450 Product Credit
  • Top drawer product training
  • Valuable Extras

Crop/Livestock Wholesale Packages

Building/Roofing Wholesale Packages

Consumer Products Wholesale Packages
Wholesale Volume Purchaser:
Package Features and Cost
  • Immediate discount to Factory Wholesale Price with minimum $7500 order
  • Volume discounts
  • ProAg I agronomy training (Training only, lodging not included)
  • Product Order Form

Premier Grower:
Package Features and Cost
  • Immediate discount to Factory Wholesale Price
  • Volume discounts
  • 16 soil tests
  • $150 product credit
  • Pro Ag I agronomy training
  • Conklin Business Seminar training
One-time enrollment fee of $1199

Standard Grower:
Package Features and Cost
  • Immediate discount to Factory Wholesale Price
  • Volume discounts
  • 16 soil tests
  • $150 product credit
  • Pro Ag I agronomy training
One-time enrollment fee of $799

Fastrack® Animal Microbials:
Package Features and Cost
  • Immediate discount to Factory Wholesale Price
  • Volume discounts
  • $450 product credit
  • Fastrack product training
One-time enrollment fee of $799 		Building/Roofing Premium Contractor:
Package Features and Cost
  • Immediate discount to Factory Wholesale Price
  • Volume discounts after training
  • Product warranty after training
  • Warranty training
  • Conklin Business Seminar training including lodging and meals
  • $150 product credit
One-time enrollment fee of $1199

Standard Contractor:
Package Features and Cost
  • Immediate discount to Factory Wholesale Price
  • Volume discounts after training
  • Product warranty after training
  • Warranty training including lodging and meals
  • $150 product credit
One-time enrollment fee of $799 		Fastrack® Companion Animal:
Package Features and Cost
  • Immediate discount to Preferred Customer pricing
  • Volume discounts after training
  • Fastrack Companion Animal Products training
  • $450 product credit
One-time enrollment fee of $799

Conklin Business Seminar:
Package Features and Cost
  • Conklin Business Seminar training
  • A one-day product training of your choice
  • $150 product credit
  • Sell all product lines
One-time enrollment fee of $799
As a wholesale or preferred customer, I am aware that I cannot participate in Conklin's compensation plan or sponsor others. I understand that I can become an Independent Business Owner (IBO) at any time by completing an IBO application and agreement.

* Contact Information

 (Required for both Customer Package and IBO Applications)
* First Name:
 Middle Initial:
 * Last Name:
* Street Address or Rural Route box number:
 Apartment, Suite, or Room:
* City: * State: * Zip Code: (5 digits only)
Your Phone Number:
Use numbers only, no dashes, spaces, or()
*
Sponsor's IBO Number: 21784335
 * Your Email Address:
Fax Number: Use numbers only, no dashes, spaces, or ()
 Cell Number: Use numbers only, no dashes, spaces or ()
* Do you reside within city limits? (Needed for tax purposes)
  Yes   No (download tax exempt forms here)
Shipping Address if different from billing address:
Street Address:
 Apartment, Suite, or Room:
City:
 State:
 Zip Code: (5 digits only)
Questions? Contact your sponsor for answers and support.

* Payment Information (PAC or Credit card)
*Payment Method Name as it appears on credit account
*		 Credit card/PAC number
*
Credit card expiration (month)
 Credit card expiration (year)
 3-digit verification code
(on back of card)
This is a legal and binding document. By submitting this form, I verify that the above information is correct and that I understand and accept the Reference Guide which is incorporated herein.