ORDER FORM
Client Name:______________________________________________________________________________________________ Address:_________________________________________________________________________________________________ City:____________________________ State:__________ Zip:__________________ Phone:____________________________ Email:____________________________________________________________________________________________________ DOB:________________________ SSN: (If Consultant option)_____________________________________________________ Quantity
Recommended Add-ons:
Product #
Product Name
Price
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Nutrition ASVP _____________________________________ _____
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Anti-Aging ASVP _____________________________________ _____
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Product Retail Total __________ OPTIONAL $79 Consultant Sign-Up __________ OPTIONAL $20 Preferred Client Sign-Up __________ Shipping __________ Tax __________ Free Product _______
Amount Due ________
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Name on Card: ________________________________ Card #: ________________________________ EXP:___________CVC:____________ Billing Zip:_______________________
Shipping & Handling
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Client / PC / Cons
___ Fit Chews 20 / 16 / 13 ___ Chocolate ___ Caramel ___ Lemon ___ Greens Balance 50 / 40 / 32.50 ___ Full Control 72 / 57.60 / 46.80 ___ ThermoBooster 65 / 52 / 42.25 ___ Sleep Well Spray 40 / 32 / 26 ___ Spray Vitamin D+B12 40 / 32 / 26 ___ Daily Vitamin Pack 102 / 81.60 / 66.30 I am interested in: ____ Hosting a group presentation ____ Learning more about the business opportunity
Product Order Total (SRP)
UPS Ground
UPS 3rd Day Air
$0–$99.99 $100–$199.99 $200–$299.99 $300–$399.99 $400–$499.99 $500–$999.99 $1,000+
$7.95 $9.75 $12.95 $14.95 $16.95 $22.45 $29.95
$14.95 $21.95 $28.95 $30.95 $32.95 $35.95 $49.95
UPS Flat Rates*
UPS 2 Day
UPS Next Day
$19.99
$29.99
*UPS 2nd Day and Next Day Air: This charge is per carton. Program details may be revised at a later date. Surcharge to Alaska, Hawaii, Puerto Rico, and U.S. Territories: Up to $249.99 order = $2.00 $250+ order = $5.00