mdftm-zija-enrollment-form by mdbn948

ZIJA BUILDER SYSTEMS & APPLICATION United States / Puerto Rico / Canada

Zija Starter System ($330/250 PV) 2 2 1 1

Cases SuperMix* Boxes XM+ Box XMam Caps Box Premium Tea

• • • • • • • •

FREE Enrollment FREE Shaker Bottle ($8 value) FREE Business Kit ($39 value) FREE 8 XMam Trial Packs ($42 value) FREE 8 XMpm Trial Packs ($42 value) FREE 8 SuperMix Pocket Guides 8 SamplePack Boxes Includes Shipping & Handling**

*Also available with SmartMix in the Zija Personal System

**Add $10 Duties & Handling for Canada

×2

Zija Speed Builder System 1 ($660/500 PV) 4 4 2 2

Cases SuperMix* Boxes XM+ Boxes XMam Caps Boxes Premium Tea

EARN 15% TEAM COMMISSIONS FOR 3 PERIODS†

• • • •

FREE FREE FREE FREE

Enrollment Shaker Bottle ($8 value) Business Kit ($39 value) 16 XMam Trial Packs ($84 value)

*Also available with SmartMix in the Zija Builder System 1

Cases SuperMix* Boxes XM+ Boxes XMam Caps Boxes Premium Tea

EARN 15% TEAM COMMISSIONS FOR 6 PERIODS†

×4

• FREE Enrollment • FREE Shaker Bottle ($8 value) • FREE Business Kit ($39 value) • FREE 32 XMam Trial Packs ($168 value)

*Also available with SmartMix in the Zija Builder System 2

FREE 16 XMpm Trial Packs ($84 value) FREE 16 SuperMix Pocket Guides 16 SamplePack Boxes Includes Shipping & Handling**

**Add $20 Duties & Handling for Canada

Zija Speed Builder System 2 ($1,320/1000 PV) 8 8 4 4

• • • •

• FREE 32 XMpm Trial Packs ($168 value) • FREE 32 SuperMix Pocket Guides • 32 SamplePack Boxes • Includes Shipping & Handling**

**Add $40 Duties & Handling for Canada

Four easy steps to maximize profit with these product systems STEP 1 Choose your System STEP 2 Choose Active 150 AutoShip (Req. to earn 15% Team Bonus)

STEP 3 Become Qualified and Active 75/150 STEP 4 Train and Duplicate

ZIJA SUPERPACKS, SMARTPACKS & PLUSPACKS BurnPack 1 ($200/150 PV)

BurnPack 2* ($200/150 PV)

1 Box of XMburn 1 Tea Combo Box

1 XMburn Pocket Guide 1 Daily Tea Pocket Guide 1 SmartMix Pocket Guide 1 XM+ Pocket Guide 1 Premium Tea Pocket . Guide

(20 Daily Tea .

& 10 Premium Tea Pouches)

1 Case of SmartMix 1 Box of XM+ 1 Zija Shaker Bottle

(20 Daily Tea .

& 10 Premium Tea Pouches)

1 Case of SmartMix 1 Box of XM+ 1 Zija Shaker Bottle

1 XMburn Pocket Guide 1 Daily Tea Pocket Guide 1 SmartMix Pocket Guide 1 XM+ Pocket Guide 1 Premium Tea Pocket . Guide

• 2 FREE XMburn Trial Packs (4 Caps per Pack) • Includes Shipping & Handling (Add $5 for Canada)

• 10 FREE XMburn Trial Packs (4 Caps per Pack) • Includes Shipping & Handling (Add $5 for Canada) • 1 FREE Issue of Zija’s Success From Home Magazine

SuperPack 1 ($200/150 PV)

SuperPack 2 ($200/150 PV)

1 1 1 2 1

Case SuperMix** Box XM+ Box XMam Caps XMpm Samples Box Premium Tea

1 WMS Guide Shaker Bottle **Also Available with SmartMix in the SmartPack 1 Includes Shipping & Handling (Add $5 for Canada)

Case SuperMix** Box XM+ Box XMpm Caps XMam Samples Box Premium Tea

1 WMS Guide Shaker Bottle **Also Available with SmartMix in the SmartPack 2 Includes Shipping & Handling (Add $5 for Canada)

SuperPack 3 ($200/150 PV) 1 1 1 2 1

Case SuperMix** Box SmartMix Box XMpm Caps XMpm Samples Box Premium Tea

1 WMS Guide Shaker Bottle **Also Available with SmartMix in the SmartPack 3 Includes Shipping & Handling (Add $5 for Canada)

*BurnPack 2 is only available as a one-time enrollment order and is only available when enrolled through the Zija Life Unlimited Mobile App

PLUS PACKS, PEAK PERFORMANCE SYSTEMS & GENM PACKS PlusPack 1 ($200/150 PV)

PlusPack 2

1 1 1 2

Case XM+ Box SmartMix Box XMam Caps XMpm Samples

1 Box Premium Tea 1 WMS Guide Shaker Bottle

Includes Shipping & Handling (Add $5 for Canada)

($200/150 PV)

Case XM+ Box SmartMix Box XMpm Caps XMam Samples

1 Box Premium Tea 1 WMS Guide Shaker Bottle

Includes Shipping & Handling (Add $5 for Canada)

Peak Performance Starter System

($330/250 PV)

1 Bag PR1ME90 Dutch Chocolate Shake 1 Case of XM+ 1 Case of SuperMix 1 Box of Premium Tea

• FREE Enrollment • FREE 1 Bag PR1ME90 Vanilla Bean Shake • FREE 1 PR1ME90 Shaker Bottle • Includes Shipping & Handling (Add $10 for Canada)

Peak Performance Speed Builder 1 ($660/500 PV)

2 Bags PR1ME90 Dutch Chocolate Shake 2 Cases of XM+ 2 Cases SuperMix 2 Boxes Premium Tea

×2

• FREE Enrollment • FREE 2 Bags PR1ME90 Vanilla Bean Shake • FREE 2 PR1ME90 Shaker Bottles • Includes Shipping & Handling (Add $20 for Canada)

Peak Performance Speed Builder 2 ($1,320/1000 PV)

4 Bags PR1ME90 Dutch Chocolate Shake 4 Cases XM+ 4 Cases SuperMix 4 Boxes Premium Tea

EARN 15% TEAM COMMISSIONS FOR 3 PERIODS†

EARN 15% TEAM COMMISSIONS FOR 6 PERIODS†

GenM Personal Pack

GenM Builder Pack

1 1 1 1 1 1 2

3 2 2 2 2 3 3

($330/250 PV)

Daily Moisturizer Rehydrating Mist Creamy Face Cleanser Spa Masque Eye Serum Anti-aging Night Repair Zija Oils

×4

• FREE Enrollment • FREE 4 Bags PR1ME90 Vanilla Bean Shake • FREE 4 PR1ME90 Shaker Bottles • Includes Shipping & Handling (Add $40 for Canada)

1 Cosmetic Bag 1 GenM Sample Pack (10 Count) 1 Skin Care Guide FREE Enrollment $14.95 Shipping & Handling (Add $5 for Canada)

($660/500 PV)

Daily Moisturizers Rehydrating Mists Creamy Face Cleansers Spa Masques Eye Serums Anti-aging Night Repairs Zija Oils

2 Cosmetic Bags 2 GenM Sample Packs (10 Count) 2 Skin Care Guides FREE Enrollment $19.95 Shipping & Handling (Add $5 for Canada)

ENROLLMENT APPLICATION 1 NEW ENROLLEE INFORMATION (required) LAST NAME

Please fax this form to: 1.801.494.2323 Individual/Sole Proprietor

p Joint Applicants

FIRST NAME

MIDDLE INITIAL

p Partnership

p Corporation

BUSINESS NAME (IF DIFFERENT FROM APPLICANT’S NAME)

MAILING ADDRESS

CITY

STATE/PR

ZIP

SOCIAL SECURITY NUMBER

SHIPPING ADDRESS (IF DIFFERENT FROM MAILING)

CITY

STATE/PR

ZIP

DATE OF BIRTH (MM/DD/YY)

PHONE NUMBER

OTHER PHONE/FAX

(

)

E-MAIL ADDRESS

)

SPONSOR’S PHONE

SPONSOR’S NAME (PLEASE PRINT)

Mother and Daughter Faith Trust Ministries (Dr. Bessie Fletcher)

SPONSOR’S ID NUMBER

( 954 ) 665-4205

2664318

2 PLACEMENT INFORMATION (Placement Name and ID Number optional) Based on the information provided in this section, you will be placed in the first available Left or Right position of the Placement Name and ID Number provided below. If no Placement Name or ID Number is provided in this section, you will be placed in the first available position on the Left or Right side of your Sponsor (listed above). PLACEMENT NAME

PLACEMENT ID NUMBER

MARK CHOICE (REQUIRED)

3 ENROLLMENT FEE / PAYMENT

4 PAYMENT OPTIONS

RIGHT

p Visa p Mastercard p AMEX p Discover

CREDIT CARD NUMBER

I understand that the $39 Enrollment Fee to become a Zija Distributor is waived with the purchase of any Zija System, which includes a Zija Business Kit containing sales and demonstration materials as well as company information created by Zija. I understand a yearly renewal fee of $25 is required to continue as a Distributor. I authorize Zija to charge the $25 annual renewal fee to my credit card as it becomes due. I understand a renewal fee is applicable annually, starting thirty (30) days prior to my enrolllment anniversary date to maintain my Distributor status.

LEFT

EXPIRATION DATE

NAME AS SHOWN ON CARD

SIGNATURE OF CARDHOLDER

BILLING ADDRESS

CITY

STATE/PR

ZIP

5 AUTOSHIP ORDER Kit/Pack Selection:

QUANTITY AUTOSHIP DESCRIPTION

PRICE

1 CASE SUPERMIX........................................................................................................$99 (75 PV)

p Zija Starter System (SuperMix) ($330/250 PV) 102056

p Zija Speed Builder System 1 (SuperMix)† ($660/500 PV) 102057

1 CASE SMARTMIX.......................................................................................................$99 (75 PV)

1 CASE XM+ ENERGY MIX............................................................................................$99 (75PV)

1 Case XM3 Energy drink (4 oz)...............................................................................$75 (50 PV)

p Zija Speed Builder System 2 (SuperMix)† ($1,320/1000 PV) 102058 p Zija Personal System (SmartMix) ($330/250 PV) 101871 p Zija Builder System 1 (SmartMix)† ($660/500 PV) 101872 p Zija Builder System 2 (SmartMix)† ($1,320/1000 PV) 101873 p Peak Performance Starter System ($330/250 PV) 102053

1 BOX XMam CAPS.......................................................................................................$59 (48 PV)

1 BOX XMpm CAPS.......................................................................................................$59 (48 PV)

15 XMam TRIAL PACKS...............................................................................................$118 (75 PV)

15 XMpm TRIAL PACKS...............................................................................................$118 (75 PV)

p Peak Performance Speed Builder 1 † ($660/500 PV) 102054

1 Box Premium Tea....................................................................................................$39 (30 PV)

p Peak Performance Speed Builder 2 † ($1320/1000 PV) 102055

1 Bag PR1ME90 Dutch Chocolate Shake................................................................$99 (75 PV)

p BURNPack 1 ($200/150 PV) 103310

1 Bag PR1ME90 Vanilla Bean Shake........................................................................$99 (75 PV)

p SuperPack 1 ($200/150 PV) usa102059

1 Daily Moisturizer...................................................................................................$39 (30 PV)

p SuperPack 2 ($200/150 PV) usa102060

1 Creamy Face Cleanser..........................................................................................$39 (30 PV)

1 Anti-Aging Night Repair........................................................................................$59 (46 PV)

1 Rehydrating Mist...................................................................................................$29 (22 PV)

1 Spa Masque.............................................................................................................$55 (42 PV)

1 Zija Oil.....................................................................................................................$39 (30 PV)

1 Eye Serum...............................................................................................................$39 (30 PV)

p SuperPack 3 ($200/150 PV) usa102061 p SmartPack 1 ($200/150 PV) 101885 p SmartPack 2 ($200/150 PV) 101886

† Option qualifies new enrollees for 15% Team Commissions.

p SmartPack 3 ($200/150 PV) 101887 p PlusPack 1 ($200/150 PV) 101888 p PlusPack 2 ($200/150 PV) 101889 p GenM Personal Pack ($330/250 PV) 101957 p GenM Builder Pack † ($660/500 PV) 101959

CUSTOMER INITIALS

TOTAL

AutoShip is a program of convenience that automatically charges and ships the products of your choice approximately every 4 weeks after the initial order. Prices shown DO NOT include S/H fees.

6 terms and conditions By signing below, I understand and have read and agree to abide by the Zija Policies & Procedures/Terms and Conditions, and that this enrollment form is abbreviated and not intended as a substitute for full disclosure of the Zija Policies & Procedures/Terms and Conditions. I understand that a complete disclosure of such documentation is available upon my request. I authorize my enrolling sponsor to process this initial order with the information I have supplied herewith. In addition, I authorize Zija to process my order and to charge my credit card referenced above. Team 250 Disclaimer – Team 250 is a program that allows Zija Distributors to earn a free AutoShip by completing certain requirements. If you qualify, Zija will pay for your AutoShip, unless you decide to opt-out below. If any of your qualifying purchases are reversed or refunded, backdated billing will apply. For more information about Team 250 rules and regulations, refer to the flyer in your Back Office. p I wish to opt-out of the Team 250 program

Applicant/Authorized Party’s Signature and Title

_______________________________________________________

Date

__________