Lamas Beauty International
  P.O. Box 90974
  Houston, TX 77290-0974
  (281) 537-7357 Tele
  (323) 936-6258 Fax

AFFIDAVIT

* Required Fields

Company Information:
Legal Company Name:	*
Contact E-mail Address:	*
Website Domain:	*
Contact Name:
Phone Number:	*
Fax Number:

IN THE MATTER OF being referred to the LamasBeauty.com's Affiliate Program by a company or individual that is currently a Lamas Beauty Affiliate.

We were referred to the Lamas Beauty Affiliate Program by:
We were referred to the Lamas Beauty Affiliate Program by:		Name of referring company or person

Their current website address is:
Their current website address is:		Website address of referring Affiliate

The date they referred us to the Lamas Beauty Affiliate Program was on:
The date they referred us to the Lamas Beauty Affiliate Program was on:		Date of referral

Signature___________________________

Title________________________

Date________

Must be signed by an authorized agent of the company.

Print Name_______________________________

By submitting this affidavit to Lamas Beauty International, you affirm that the company you named above referred you to the Lamas Beauty Affiliate Program.

Please mail this form to the above address or fax a signed copy to 323-936-6258