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HONESTY Rx CARD

Representative Enrollment Application

Last Name

First Name

Company Name (optional) Checks are issued in company name if included on application.

Billing Address

Apt. or Suite #

City

State

Zip Code

State

City

Apt. or Suite #

Shipping Address

(If Different From Above)

Please do NOT use PO Boxes

Home Phone

Cell Phone

Work Phone

Fax

Additional Information

Social Security #

Tax ID or EIN#

Email Address

Sponsor Information

Sponsor's Name

Sponsor's Group #

Sponsor's Home or Cell Phone

Sponsor's Email

Honesty Rx Card Policies and Procedures (please read)

I have read, understand, and acknowledge the Honesty Rx, LLC Privacy Statement above.

Once we receive your enrollment form, we will email you everything you need to get started. Then, our Dircector of Operations will contact you within 24 hours to welcome you to our team.

All New Representatives Will Receive a Welcome Packet

Including:

**Tips On How To Get Started

**50 Free Discount Cards

Occupation

$59.99 Enrollment Fee

Includes:

Personal Website

Online Card Printing

Pharmacy Locator

Representative Back Office

Prescription Card

Template

Website Extension 2nd

Choice

Website Extension 1st

Choice

(For example, www.hrxcard.com/saveonrx, www.hrxcard.com/Monica, etc.)

Honesty Rx Card Policies & Procedures

I am of legal age in the state of my residency. I agree that I am an independent contractor, responsible for determining my own business activities without control or direction by Honesty Rx Card, LLC, and not an agent, employee or legal representative of Honesty.

I will not represent in any manner that I am an agent or legal representative of Honesty. 
I understand that the Initial Representative Fee of $59.99 is due immediately upon enrollment with Honest Rx.  The yearly $14.99 Renewal Fee is due each year within 7 days of the Representatives enrollment anniversary date.  Representatives will be notified by email the prior month of the need to renew.  Any renewal fees received after the 7 day grace period will result in termination of the Representative’s Status as an Honesty Rx Representative and also results in forfeit of any unpaid commissions.

I understand that I will be paid a sum of .75 cents for each compensable claim that has been adjudicated with my individual group number.  I also understand that if a claim is considered uncompensable, or a claim is reversed or does not result in a paid claim for any reason, I will not be paid for that claim.  I also understand that some agencies require a 30 day period to process prescription claims.  Claims of this type will not be considered paid until such time as the agency submits payment.

I understand that commission levels are increased based on performance, healthcare
knowledge, and tenure with Honesty and that commission levels vary between representatives.

I am responsible for the payment of all federal and state self-employment taxes and any other tax required under any federal, state or regulatory taxing agency.

This agreement does not constitute the sale or purchase of a franchise or of a business opportunity.

I agree that as a Managing Representative, I shall place primary emphasis upon the acquisition of new customers for Honesty.

Honesty Rx or I may terminate this agreement for any reason at any time, by giving the other party written notice via mail, fax or email at the respective contact point with Honesty Rx's being noted on the corporate website (www.hrxcard.com).

I understand that my personal tracking ID number (Group ID# on member card) will be activated by completing the Online Enrollment Application @ www.hrxcard.com

In order to maintain a viable Marketing Program and to comply with changes in federal, state or local laws and economic conditions within the industry, Honesty may provide additional and modified Policies and Procedures for Management Representatives from time to time, as well as to modify its Compensation Plan. Such Policies and Procedures, additions and modifications and Compensation Plan modifications, and all changes thereto, shall become a binding part of this Agreement.

I also acknowledge that at any time, to maintain a viable Marketing Program, Honesty may institute a one-time and/or monthly membership fee.  Notification of Such Policies and Procedures additions and modifications shall be made to Representatives 30 calendar days prior to implementation.  Such Policies and Procedures, additions and modifications shall become a binding part of this Agreement.  Failure of a Representative to adhere to these changes, including non-payment of Membership fees, shall constitute breach of this agreement and subject the Representative to termination.

I acknowledge that Honesty Rx Card is a discount healthcare program that provides products and services to end users and from time to time those products, services and rates shall be subject to change without prior notice.

I understand that no Attorney General or other regulatory authority ever reviews, endorses or approves any marketing plan or compensation plan, and I will make no such claim to others.

I understand that my Representative position can be inherited, bequeathed, transferred, assigned or sold, but it does require the written consent of Honesty which consent will not be unreasonably withheld. Two months (60 days) of continuous sales inactivity as a  Management Representative (i.e., 0 monthly prescriptions processed against my Group number) may result in automatic termination of Representative status.

This Agreement shall not be deemed in effect until receipt and acceptance of your application by Honesty, at its Main Office in Mobile, Alabama.

A sole proprietorship, partnership, Limited Liability Company or Corporation may become an Independent Representative subject to review and approval by Honesty. However, no individual may hold an interest in more than one position.

I acknowledge and agree to follow the additional guidelines established in the Policies and Procedures incorporated by reference to this agreement. I will not promote my Management Representative business nor use Honesty’s name or the trade names, logos, sales materials, trademarks or service marks of Honesty, except in materials provided by Honesty or approved in writing by Honesty prior to their use by me. I understand that unauthorized use or duplication of trademarks or copyrighted materials is a violation of federal law.

Management Representatives shall utilize only those forms and promotional materials provided by Honesty

Honesty shall periodically make various sales literature and/or promotional material available at a cost. I however, am under no obligation to purchase any quantities of those materials or literature at any time. I will have the option to order and purchase any sales literature and/or promotional materials which I may choose.

To protect the integrity of the Honesty Rx Card and to prevent false and misleading claims, all Representatives must order discount cards through Honesty.  If a Representative would like to purchase their Honesty Rx Card template to print their discount cards themselves, contact Customer Care OR order your template online.

To help jump start your business, Honesty Rx Card will provide first time Management Representatives with 50 Discount Prescription Cards at no charge.  I understand that Honesty may charge a shipping fee for these cards in the future if deemed necessary.

Additional Honesty Rx Cards must be ordered through our website @ www.hrxcard.com.

I understand that I will not receive a commission check until my commission is $25.00

I also understand that commission checks less than $25.00 will be rolled over to the next month or until such time that the commission check total is $25.00 or greater.

Honesty Rx Card will send you a monthly report via email with your total claims for that month (Please make sure you keep a valid email address on file)

Honesty strongly recommends that all Representatives get free Pay Pal Accounts to expedite purchases as well as Representative’s payments.
(after you register with Pay Pal please Contact Customer Care @ 877-452-3895 and provide all pertinent information)

Checks are mailed on the 20th of each month.

I am responsible for supervising and supporting Management Representatives I sponsor into the program and in my organization by way of any of the following, or combination thereof, personal contact, telephone and internet communication, written communication, and attendance at Management Representatives meetings.

I acknowledge that as an Management Representative, I am not guaranteed any income nor am I assured any profits or success, and I certify that no claims or guaranteed profits or representations of expected earnings that might result from my efforts as an Independent Representative have been made by Honesty or my sponsor.

I will not make false or misleading statements about Honesty or the Management Representative positions.

Display of commission checks and the making of income projections to prospective
Representatives are prohibited. Demonstration of how the compensation plan works shall be strictly according to the approved Presentation by Honesty and in each presentation the prospect shall be directly informed that such demonstration is not intended to be a projection of income.
I agree that as a Management Representative, this Agreement with Honesty grants me the limited authority to promote and market Honesty products and services which Honesty markets, subject to the terms and conditions established by Honesty from time to time.

Honesty conducts business in a professional and ethical manner and mandates that all Management Representatives deal with other Representatives, Customers and Honesty in the same manner.

Honesty reserves the right to use its judgment in deciding whether certain activities are improper, unethical or illegal. Honesty, in its sole discretion, will decide the appropriate corrective action if it determines that unprofessional, unethical or illegal activities exist and reserves the right to suspend or terminate any Management Representatives' status, including but not limited to all commissions and bonuses.

In the process of selling or otherwise promoting the Honesty products or services, I agree that I, as an Management Representative, will operate in a lawful, ethical, and moral manner and I agree to make no false or misleading statements regarding the various products or services. I further agree to stay educated on and abide by
all Federal, State and local legal statutes governing the sale or solicitation of the products and services marketed by Honesty.

I agree to abide by all solicitation laws, and to obey all  solicitation signs associated with businesses I may approach, in particular Doctor's Offices, Pharmacies, Clinics, etc. In addition, it is prohibited to stand inside or outside any business and directly or indirectly distribute cards to individuals for any reason.

Honesty shall not be liable under any circumstances for any indirect, special, punitive, compensatory or consequential damages or loss of production or profits which may result from any cause, including, but not limited to, breach of warranty, delay, act, error or omission. Rather the obligations of Honesty are limited to the use of best efforts to process enrolled customers and assist those customers in accessing the desired service.

This Agreement is governed by the laws of Alabama. The parties agree that any claim, dispute or other difference between them shall be exclusively resolved by binding arbitration pursuant to the Commercial Arbitration Rules of the American Arbitration Association with arbitration to occur at Mobile, AL. Louisiana residents may choose to arbitrate in New Orleans.

HONESTY PRIVACY STATEMENT

Your privacy is important to HONESTY.  This privacy statement provides information about the personal information that HONESTY collects, and the ways in which HONESTY uses that personal information.

Personal information collection

HONESTY may collect and use the following kinds of personal information:

	[information about your use of this website (including preferences, pages visited, etc.]);] 
	[information that you provide using for the purpose of registering with the website 
	[information about transactions carried out over this website  
	[information that you provide for the purpose of subscribing to the website services and]
	[any other information that you send to HONESTY.]

Using personal information

HONESTY may use your personal information to:

	[administer this website;]
	[personalize the website for you;]
	[enable your access to and use of the website services;]
	[publish information about you on the website;]
	[send to you products that you purchase;]
	[supply to you services that you purchase;]
	[send you statements and invoices;]
	[collect payments from you; and]
	[send you marketing communications.]

Where HONESTY discloses your personal information to its agents or sub-contractors for these purposes, the agent or sub-contractor in question will be obligated to use that personal information in accordance with the terms of this privacy statement.

In addition to the disclosures reasonably necessary for the purposes identified elsewhere above, HONESTY may disclose your personal information to the extent that it is required to do so by law, in connection with any legal proceedings or prospective legal proceedings, and in order to establish, exercise or defend its legal rights.

Securing your data

HONESTY will take reasonable technical and organisational precautions to prevent the loss, misuse or alteration of your personal information.

HONESTY will store all the personal information you provide on its secure servers.

[Information relating to electronic transactions entered into via this website will be protected by encryption technology.]

Cross-border data transfers

Information that HONESTY collects may be stored and processed in and transferred between any of the countries in which HONESTY operates to enable the use of the information in accordance with this privacy policy.

[In addition, personal information that you submit for publication on the website will be published on the internet and may be available around the world.]

You agree to such cross-border transfers of personal information.

Updating this statement

HONESTY may update this privacy policy by posting a new version on this website.

You should check this page occasionally to ensure you are familiar with any changes.

Other websites

This website contains links to other websites.

HONESTY is not responsible for the privacy policies or practices of any third party.

Contact HONESTY

If you have any questions about this privacy policy or HONESTY’S treatment of your personal information, please write to:

	by email to hrxcardsupport@gmail.com; or 
	by post to P.O. BOX 180553 Mobile, AL 36618.

This privacy statement

This privacy statement is based on a precedent created by employmentlawcontracts.co.uk and published by freenetlaw.com.

Non Disclosure Agreement

WHEREAS, parties contemplate discussions and analyses concerning Discount Pharmacy Cash Card Distribution; and
                                                                       
	WHEREAS, in order to facilitate such discussions and analyses, certain confidential and proprietary technical and/or financial information may be disclosed between the parties orally or in writing:

THEREFORE, in consideration of the mutual covenants contained herein, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree to the following:

1.	Each party will disclose Confidential Information to the other party for the sole purpose of discussing and analyzing Discount Pharmacy Cash Card Distribution

2.	“Confidential Information” as defined in this Agreement shall mean information of a confidential and proprietary nature that is disclosed by either party for the purposes of this Agreement and shall include confidential information relative to the disclosing party’s finances, assets, information technology (including computer programs, source codes and applications related thereto), formulas, patents, trademarks, trade secrets and other proprietary customer and pricing information and any other information designated by a party as confidential. The provisions of this Agreement shall also be deemed Confidential Information.

3.	The obligations imposed upon either party herein shall not apply to Confidential Information:
a.	which has already or subsequently becomes available to the public through no wrongful act; or
b.	which may be published prior to the date hereof; or
c.	which is already in the possession of the receiving party and not subject to an existing agreement of confidence between the parties; or
d.	which is received from a third party without restriction and without breach of this Agreement; or
e.	which is independently developed by the receiving party; or	
f.	which is disclosed pursuant to a requirement or request of a government agency, legal process, or an order of court.

4.	All Confidential Information furnished by one party to the other is considered loaned for use solely for the purposes described above and which may be requested or required pursuant to this Agreement, and shall be returned or destroyed by the receiving party to the disclosing party upon request by the disclosing party.  Upon written request the receiving party shall certify that it has destroyed or returned all copies of the Confidential Information in its possession.  Except as permitted or contemplated in this Agreement neither party shall disclose the other party’s Confidential Information to any third party without the other party’s prior written consent, and will protect the Confidential Information by using the same degree of care (but no less than a reasonable degree of care) as the recipient uses to protect its own similar confidential data.  Each party will use the Confidential Information only for the purposes described above.

5.	Each party may give Confidential Information to its employees, contractors and consultants, if those individuals need to know it to assist the recipient to accomplish the purposes described in Section 1 above.  Such individuals must first be bound by nondisclosure agreements with the recipient (which may be general in form) limiting their right to use such information to the purposes for which they receive it or agree to be bound pursuant to the terms of this Agreement.  The recipient will use reasonable commercial efforts to enforce the nondisclosure agreements this section requires.

6.	Each Party acknowledges that money damages may not be a sufficient remedy for any breach of this Agreement by the other Party (the “Breaching Party”) or such Breaching Party’s Representatives and that the non-breaching Party (the “Non-Breaching Party”) may suffer irreparable harm as a result of any such breach.  Accordingly, the Non-Breaching Party will also be entitled to seek equitable relief, including injunction and specific performance (without the requirement of any bond) as a remedy for any breach or threatened breach of this Agreement. The equitable remedies will not be deemed to be the exclusive remedies for a breach of this Agreement, but rather will be in addition to all other remedies available at law or in equity to the Non-Breaching Party.  In the event of litigation relating to this Agreement, if a court of competent jurisdiction determines that the Breaching Party or any of its Representatives has breached this Agreement, such Breaching Party will be liable for, and will pay to the Non-Breaching Party and its Representatives, the reasonable legal fees incurred by the Non-Breaching Party and the Non-Breaching Party’s Representatives in connection with such litigation (including any appeal relating thereto).

7.	For a period of two (2) years from the date of this Agreement, disclosed Confidential Information, unless written consent is otherwise granted by the disclosing party, shall be restricted to those employees and persons in the receiving party's organization with a need to know in order to perform services specifically requested by one party of the other in order to fulfill the purpose of this Agreement. Upon the termination of this Agreement or the purpose for entering into this Agreement each party agrees to continue to protect the Confidential Information provided by the other for so long as such information retains its confidential and proprietary nature.

8.	Recepient agrees to inform the providing Party of any unauthorized disclosure of Confidential information within 10 days of becoming aware of such disclosure.

9.	No furnishing of Confidential Information and no obligation hereunder shall obligate either party to enter into any further agreement or negotiation with the other or to refrain from entering into an agreement or negotiation with any other party.

10.	Each party, in disclosing information to the other party pursuant to this Agreement, warrants it has the right to disclose the Confidential Information it gives.

11.	This Agreement constitutes the entire agreement between the parties and supersedes any prior or contemporaneous oral or written representations with regard to the subject matter hereof.  This Agreement may be changed or modified only by written amendment signed by both parties.

12.	No party makes any representation, express or implied, as to the accuracy or completeness of the Confidential Information disclosed by it.

13.	Except as may be required by law Management Reps and Honesty Rx shall not disclose the fact of their discussions, or any information concerning their discussions to third parties and shall keep any such information in strict confidence.

14.	This Agreement will be governed by and construed in accordance with the laws of the State of Alabama without giving effect to principles of conflicts of laws.

15.	This Agreement may be executed in one or more counterparts, each of which shall be deemed an original but which together shall constitute the same instrument.  Each party agrees to be bound by its own telecopied or facsimiled signature, and agrees that it accepts the telecopied or facsimiled signature of the other party hereto.

16.	This agreement shall bind and inure to the benefit of the Parties and their succsessors and assigns.