Fields marked with * are mandatory.
I/WE recognize that Healthy Boost, Inc., is not in any way obligated to License a Healthy Boost Kiosk or promise of employments to ME/US because of MY/OUR execution of this document. I/WE acknowledge that any false statement on this application shall be considered sufficient cause to deny any further consideration or cause revocation of any signed agreement with Healthy Boost, Inc. I/WE understand that any inquiry regarding MY/OUR character, general reputation, personal characteristics, financial background and general fitness for being a Healthy Boost License may be made as a result of this application. In addition, by signing below I/WE release any and all former and/or present employers, and any other personal or business references, from any liability whatsoever in connection with Healthy Boost's attempt to investigate MY/OUR background and determine MY/OUR fitness to become a Healthy Boost License. I/WE specifically authorize Healthy Boost to obtain credit reports from one or more credit bureaus and background check on ME/US and MY/OUR business(es). A copy of this authorization may be used in place of and shall be valid as the original. I/WE understand that this application is considered active for 180 days from the date below. By submitting this application I/WE agree that this information is correct and I/WE give Healthy Boost, Inc., permission to obtain a Credit Report and Background Report for the individuals listed on this application. I understand and acknowledge that if I am married but do not provide complete information for myself and my spouse, Healthy Boost, Inc. cannot process this application.
Want to be notified on new product releases? Just sign up and we’ll send you a notification by email.