Enrollment Documents

8/7/2019 Enrollment Documents

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Schedule MyChallenge Party F

Date: __________

Rfr 3 Gt Yours Fr! As a Body by Vi Challng Kit Customr or Distributor, simply us your ID # and yourprsonal BodyByVi.com wbsit to rfr at last 3 othr Customrs to a Challng Kit and you could gt your kit for FRee nxt month.

To qualify for your FREE Kit, the 3 (or more) orders must be Challenge Kit Customers (not Distributors) with a total sales volume of at least three times that of your personal Challenge Kit.

All 3 orders must be on Auto-Ship, and be placed within the same calendar month. L imited to one free kit per person per month. Tax, shipping & handling still apply.

Balance your nutrition with thisonce-daily boost to your health.

Benefts: 30 Full Meals!The shake mix that tastes like a cake mix

Lowest sugar, at and sodiumo leading brandsConcentrated, pure proteinDigestive, ber, and heart healthbenetsMaximum nutrient absorptionIncludes 1 packet each o our 5Shape-Up Health Flavor Mix-Ins

Support your active liestylewith balanced nutrition andan advanced anti-aging and

energy system.

Benefts: 30 Full Meals!The benets o the Balance Kit plus:

Energy, stamina and hydration

Molecularly-distilled Omega Oils;Chelated Multi-Mineral & Vitamin

Supercharged Antioxidant with a

powerul blend o 26 o naturesrichest sources;

Patented Anti-Aging & Energy formula

See results and help shapeyour body with 60 power-

packed meals.

Benefts: 60 Full MealThe benets o the Balance Kit butwith two shakes per day or asterresults.Includes 2 samples each o all 5 o oShape-Up Health Flavor Mix-Ins oadded benets and favor variety.

Ultimate shaping and nutritionsupport to help you transormyour body and eel maximum

results.

Benefts: 60 Full MealThe benets o the Shape Kit plus:

Energy, stamina and hydration

Healthy oxygen transerSupports healthy blood sugar leve

Supports natural insulin unction

Promotes lean muscle and fat burn

Helps inhibit at production

Appetite & metabolism supportHealthy heart support

Balance Kit$49

$77 Retail Value

Save $28

Core Kit$199

$287 Retail ValueSave $88

Shape Kit$99

$144 Retail Value

Save $45

Transformation

Kit$249

$349 Retail ValueSave $100

Auto-ShipPrice

Auto-ShipPrice

Auto-ShipPrice

Auto-ShipPrice

Customer Shipping Inormation

ast Name: _______________________ First Name: ______________________

hipping Address: ___________________________________ _______________

pt/Suite: ______________________________________________________

ty: ___________________________ State: ______ Zip: ______________

aytime Phone #: __________________________________________________

-mail Address: ___________________________________________________

Yes, I would like to receive communications fr om ViSalus regarding special discountsand promotions.

ll in the Name and ID number of the ViSalus Customer or Distributor signing you up today:


D # or SSN: ______________________________________________________

Customer Billing Inormation

Full Name on Credit Card: _________________________________ __________

Billing Address: _________________________________________________

Apt/Suite: ____________________________________________________

City: ___________________________ State: ______ Zip: ____________

Credit Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|_

Expiration Date: ____________________ Security Code: __________________

Card Type: Visa MasterCard Discover American Express

Cardholder Signature: ___________ __________________________________

I authorize ViSalus Sciences to charge my account for the amount listed. I promise to pay such amount to an

in agreement governing the use of such card. I understand that ViSalus Sciences will apply Taxes, Shipping

and Handling charges to my order. If order is Auto-Ship, I authorize ViSalus to ship these products monthly

Cancellations must be submitted 5 days prior to the Auto-Ship date.ax Form to 877.547.1570 2010 ViSalus S ciences 1607 E. Big Beaver Rd. Suite. 110, Troy,MI 48083 1-877-VISALUS www.visalus.com D105

Auto-Ship My Order YES!Check one date: 5th 12th 19th

Add the Vi-pak to

your Challenge Kit

(Auto-Ship Only)

Only $99 Add th nw Nutra-Cooki to yourordr. Only $34 per box!Auto-Ship Price

Chocolate Chip Oatmeal Raisin

NeW!ViSalusNutraCooki
http://www.visalusshakes.com/http://www.visalusshakes.com/


2/6

$1,125 Value!

$1,751 Value!

ax Form to 877.547.1570 2010 ViSalus S ciences 1607 E. Big Beaver Rd. Suite. 110, Troy,MI 48083 1-877-VISALUS www.visalus.com D102

Become a ViSalus Independent Distributor and start earning money & rewards

for referring others to the ViSalus Products and Opportunity!

ESS with Samples $999

Executive Success System (ESS) $499

Basic Distributorship $49

Executive Success Systemplus 50 Taster Packs and25 Starter Packs

Everything you need to launch your business.

More Product Value More Special Incentives

Weekly Enrollers Pool!Average check in 2009 was $165 per week!

ViSalus Bimmer Club$600 per month lifetime BMW bonus

at Regional Director.

More Education & Mentorshi

Executive Mentorship Series:Billion Dollar Beliefs

Cashing In on Facebook

Lucky 7: Attract prosperityto your life NOW

Tax Breaks: Secrets of the Wealthy

ViSalus Executive Success ClubOne month free. (Included with Vi-Net Pro Subscription)

L E E HI CK

LE E HI CK

TheViSalusMissionfrom the Founders

i

Presents

il

i

ViSalus

Welcome Kit

OVER

$500

INPRODUC

TS

50 FREEONLINE

BOOKS &LECTURES

x50 x25

OVER$600INSAMPLES

WEEKLY

POOL


3/6

Independent Distributor (ID) Application1607 E Big Beaver Rd Suite #110, Troy, M

Customer Service 1.877.V

Fax Form to 877.547

2010 ViSalus Sciences All Rights Reserved. D1000US-

STEP 5: Personal Information

STEP 3: Additional Products

I neither Username choice is

available, username will deault to

your mailbox number.

(1st Choice):________________

(2nd Choice): _______________

Passwordsmust have 616

characters and contain at least o

letter and one number, e.g., rsm

____________________

STEP 4: Vi-Net Login & Additional Tools

Applicant Signature: X _________________________________________________________________________ Date: ______________________________

This application is not considered complete unless ViSalus receives both the signed and dated Application (page 1) and the initialed Terms o Agreement (page 2)

Enroller ID# or SSN: _______________________________________________

Enroller Last Name: __________________ First Name: ______________________The Enroller is an existing ID that reers a new ID. The Enroller can place the new ID anywhere in the depth o his/her organization.

Once the enrollment process is complete the enroller can add/change sponsor inormation in the Waiting Roomound in Vi-Net.

Last Name: ______________________ First Name:_____________________

SSN or Tax ID: _____________________ Birth Date: ____/ ____/ _____

Company Name: ___________________________________________________I doing business as a legal entity, complete and attach the Company Enrollment Form. (Required)

Sipping/Mailing Address: __________________________________________

Apt/Suite: ______________________________________________________

City: ___________________________ State: ______ Zip: ______________

Billing Address: __________________________________________________

Apt/Suite: ______________________________________________________

City: ___________________________ State: ______ Zip: ______________

Communication Preferences:

Home Phone #: ____________________ Mobile Phone #: ________________

Mobile Phone Provider: Required or ViSalus Mobile Updates (SMS)_____________________

E-mail Address: ________________________________________________

Receive ViSalus News & Updates via: Check at least one

Phone Email Mobile Text Message (SMS) None

Language Preerence: English Spanish Both

Gender: Male Female

Billing Information:

Full Name on Credit Card: _________________________________ _________

Credit Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__

Expiration Date: ____________________ Security Code: _________________

Card Type: (circle one)

Cardholder Signature: _____________________________________________

I authorize ViSalus Sciences to charge my account or the amount listed. I promise to pay such amount to and in agreement governing the use o such card. I understand that ViSalus Sciences will apply Taxes, Shipping and Handlingcharges to my order. I order is Auto-Ship or monthly Vi-Net Subscription, I authorize ViSalus to ship/charge these products monthly. Cancellations must be submitted at least 5 days prior to the Auto-Ship date or Vi-Net billing date.

See Product Price Sheet or Item Numbers and pricing inormation.

Ame

All additional product orders will be processed and shipped with your enrollment package.

QTY ITEM # DESCRIPTION AUTO-ShIP ONE-TIME

You will automatically be subscribed to Vi-Net ProplusViSalus Executive Success Club Subscription for $24/mo.

To change orcancel, call ViSalus Customer Service at 1-877-VISAL

Basic Distributorship . . $49 Executive Success System (ESS) . . . . . . . . . . . . . . . . . . $499 $1,125 Value!

ESS with Samples . . . .$ $1,751 Va

2%BV

LE ERSHIP P CK

L E ERSHIPP CK

STEP 1: Join Our Team please choose an enrollment option

STEP 2: Create Your Auto-Ship Choose the items you would like shipped to you each month.

Additional25 Starter Packs$250 $313 Value!

Additional50 Taster Packs$250 $313 Value!

ESS enrollment Auto-Ship orders wbe processed and shipped startingnext month on the selected date.Basic enrollment Auto-Ship orderbe processed and shipped with yoenrollment package.If selected dalands on a weekend or holiday, orbe processed the last business day

Coose your Auto-Sip da

5th 12th

QTY

QTY

30 ChildrensMeals Donation$24Meal for Meal Match!

QTY

AutoShip

Join the Body by Vi Challengecommun

ity! Please select a unique username and password to access your ViSalus Back

I understand that to become an Independent Distributor (ID) o ViSalus I am only required to submit this

Agreement. I urther acknowledge that my advancement in the ViSalus marketing plan is based solely upon

the acquisition o customers. My purchase o sales aids or training material, or attendance at training classes, is

strictly optional and at my discretion. I also understand that i I choose to enroll or sponsor other individuals to

participate in ViSalus marketing plan, I will only be compensated based upon the activities o other IDs to the

extent o their sales made to customers.

By my signature below and initials on the ID Terms o Agreement on the reverse side, I acknowledge that I have

careully read this Agreement and I am willing to accept the terms and conditions herein and on the reverse side.

I understand that the terms o this document shall be a binding Agreement between ViSalus and me and

receipt o this Agreement. I have read and understand ViSalus Policies and Procedures and Compensation

which are incorporated by the reerence herein, and agree to abide by them as they may be amended a

time.

I UNDERSTAND ThAT I MAY CANCEL ThIS AGREEMENT WIThOUT PENALTY OR OBLIGATION AT ANY T

FOR ANY REASON. I UNDERSTAND ThAT MY NOTICE OF CANCELLATION MUST BE SUBMITTED IN WR

TO ThE COMPANY AT ITS PRINCIPAL BUSINESS ADDRESS. PLEASE SEE OThER SIDE FOR TERMS.

Balance Kit$49

$77 Retail Value

Save $28

Core Kit$199

$287 Retail Value

Save $88

Shape Kit$99

$144 Retail Value

Save $45

Transformation

Kit$249

$349 Retail Value

Save $100

Add Vi-pakto my Challenge Kit

$99 Save $51

Mentorship Series x50 x

OVER$60

INSAMP

OVER$500

INPRODUCTS

Add Nutra-Cookies to

your order!$34/box

Chocolate Chip

Oatmeal Raisin

QTY


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1607 E Big Beaver Rd Suite #110, Troy, MCustomer Service 1.877.V

Fax Form to 877.547

2010 ViSalus Sciences All Rights Reserved. D1000US-

ID Terms of Agreement

I acknowledge that I am o legal age to enter into this Agreement.

I understand and acknowledge that this Agreement is not binding until received and accepted

by VISALUS.

I agree that as a Distributor, I am responsible or determining my own business activities and

that I am not an agent, employee or legal representative o VISALUS. I am responsible or the

payment o all ederal and state employment taxes and any other tax required under any

ederal, state or regulatory law. In the event that I ail to provide VISALUS a valid Social Security

Number or employer identifcation number, VISALUS may withhold commissions due to me

until a valid number is provided.I understand that I am not being sold a ranchise or business opportunity.

I may terminate this Agreement or any reason, at any time, by giving VISALUS prior written

notice. VISALUS may terminate this Agreement in writing upon violation o policies and

procedures or in the event I violate any part o this Agreement. In such event, no urther

commissions will be paid by VISALUS. To terminate this Agreement, I must mail or deliver

personally to VISALUS, a signed, dated written notice o cancellation sent to: ViSalus Scie nces,

1607 East Big Beave r, Suite 110, Troy, Michigan 48083.

I agree that as a VISALUS Distributor, I shall place primary emphasis upon the sale o Products

and Services to non-distributor consumers as a condition o my receipt o commissions.

Commissions I receive will be based upon ulflling certain terms o qualifcation as set orth by

the Marketing Program and Compensation Plans as may be amended rom time to time. A three

($3.00) Dollar processing ee will apply to all payments.

I agree to keep accurate records and to abide by all ederal, state, and local laws and regulationsgoverning the sale or solicitation o the products and services marketed by VISALUS including,

but not limited to, any and all permits and licenses required to perorm under this Agreement.

I understand that no attorney general or other regulatory authority ever reviews, endorses,

or approves any product, subscription, compensation program or company, and I will make no

such claim to others.

I understand that a $25 Administration Fee will be charged annually to my credit card on fle

with ViSalus. This ee is or services, which include, but are not limited to, downline reporting,

customer tracking and accounting services. The Administration Fee will be charged in the

month o my enrollment anniversary and i not paid will result in my Distributorship being

placed on Financial Hold or up to 120 days. I the Administration Fee remains unpaid 120 days

ater it was due, my Distributorship will be terminated and I will oreit any commissions that

were held since the time I was placed on Financial Hold. I my Distributorship is terminated, I

understand that I must re-enroll as a brand new Distributor and will not be placed back in my

original spot i I wish to pursue the ViSalus opportunityI agree that VISALUS shall not be liable under any circumstances or any damage or loss o any0.

kind, including indirect, special, punitive, compensatory, or consequential damages, losses or

profts which may result rom any cause, including but not limited to, breach o warranty, delay,

act, error or omission o VISALUS, or in the event o discontinuation or modifcation o a product

or service oered by VISALUS.

VISALUS shall periodically make sales literature and/or promotional materials available.1.

However, I am under no obligation to purchase any materials or literature at any time. Reunds

shall not be allowed under any circumstances, including, but not limited to, termination o this

Agreement, obsolescence o such sales literature or promotional materials, or any other reason.

Except as specifed in paragraph 24.

I agree that as a Distributor, this Agreement grants me the limited authority to promote and2.

sell the products VISALUS markets subject to the terms and conditions established by VISALUS

rom time to time.

I will not make any alse or misleading statements about VISALUS or its marketing program.3.

I agree that I will operate in a lawul, ethical and moral manner and will not engage in or

perorm any misleading, deceptive or unethical practices. In the event I violate any o these

conditions, my position may be terminated without urther payment or compensation o

any kind.

I acknowledge that I am responsible or supervising and supporting Distributors I sponsor into4.

the program and in my commissionable network. I agree to maintain monthly communication

and support to those individuals in my commissionable network through written or verbal

communication and attendance at meetings.

I acknowledge that VISALUS expressly reserves all proprietary rights to the company name,5.

logo, trademarks, service marks (Proprietary Marks) and copyrighted materials. I understand,

acknowledge and agree that any monies which I pay VISALUS are in consideration o my

receiving a non-exclusive license, during the term o this Agreement to use the Proprietary

Marks o VISALUS in conjunction with the marketing program provided to me. I urther agree

that I will not use VISALUSs Proprietary Marks in any orm whatsoever except as permitte

writing by VISALUS or in advertising or promotion materials provided, designed or publis

by VISALUS. I understand that I may not photocopy or duplicate any materials provided b

purchased rom VISALUS without written authorization and that the unauthorized use o

Proprietary Mark is a violation o ederal law and this Agreement, constituting grounds o

termination o this Agreement by VISALUS.

I understand that as a Distributor, I am ree to select my own means, methods and manne16.

o operation and that I am ree to choose the hours and location o my activities under th

Agreement, subject only to the terms o this Agreement and VISALUS Policies and ProcedI acknowledge that I am not guaranteed any income nor am I assured any profts or succe17.

I certiy that no claims o guaranteed profts or representations o expected earnings that

might result rom my eorts have been made by VISALUS or any VISALUS Distributors. In

connection, I shall not represent directly or indirectly that any person may, can or will ear

stated gross or net amount, nor that sponsorship o others is easy to secure or retain, or t

substantially all Distributors will succeed.

I acknowledge that I have the right to sign up as many personal customers as I wish. I wil18.

receive a commission each month rom my personal customers purchases and my downl

network in accordance with the VISALUS Compensation Plan then in eect.

I agree to indemniy and hold harmless VISALUS rom any and all claims losses, damages 19.

expenses, including any attorneys ees, arising out o my actions or conduct in violation o

Agreement, Compensation Plan or any Policy or Procedure o VISALUS. I agree that in orde

recoup any damages and expenses it has incurred due to such violation(s), VISALUS may o

any commissions or other payments due me. In the event a dispute arises as to the respec

rights, duties and obligations under this Agreement, Compensation Plan or the Policies an

Procedures o VISALUS, it is agreed that such disputes shall be exclusively resolved in the C

Court or Oakland County, State o Michigan, or Federal Court located in Detroit, Michigan

Michigan law shall apply to the resolution o all disputes. Louisiana residents may choose

Louisiana law and jurisdiction.

I acknowledge that I have read and ully understand the VISALUS Policies and Procedures20.

Compensation Plan, which are incorporated herein by reerence and are binding upon me

order to maintain a viable marketing program and to comply with changes in ederal, sta

local laws or economic conditions, VISALUS may revise its Compensation Plan and Policie

Procedures rom time to time. All changes thereto shall be eective upon verbal or writte

notice to me and become a binding part o this Agreement. The home ofce prior to use o

publication must approve all advertisements using the Proprietary Marks o VISALUS.

I acknowledge that this Agreement, Compensation Plan and the Policies and Procedures21. incorporated herein by reerence, constitute the entire Agreement between the parties a

shall not be modifed or amended except in writing signed by VISALUS. This Agreement s

be binding upon and inure to the beneft o heirs, successors, and permitted assigns o th

parties hereto. I any provision o the Agreement is determined by any authority o compe

jurisdiction to be invalid or unenorceable in part or in whole or any reason whatsoever, t

validity o the remaining provisions or portions thereo shall not be aected thereby.

I agree to abide by the terms o the nonintererence and non-disclosure policy o VISALUS22.

During the term o this Agreement (and any renewals), I will not sell any other products 23.

any entity competing with VISALUS. During the term o this Agreement (and any renewal

and or one (1) year thereater, I will not solicit or recruit, VISALUS employees or Distribut

whether active or inactive, to participate in a network marketing program whether or no

marketing company oers products. I acknowledge that my violation o this provision wi

result in immediate termination o my Distributorship and payments o any kind.

ViSalus ESS and Business Opportunity Return Policy: An Independent Distributor who can24.their Distributorship within 30 days o enrollment may return unused products rom the

Executive Success System which are unopened and in resalable condit ion. A reund will b

issued or the value o the Business Opportunity ($49) and the value o unused and salea

products up to $450. I an Independent Distributor cancels their Distributorsh ip within t

frst year but more than 30 days ater their enrollment date, the same guidelines apply ho

returned, saleable products will result in a product credit equal to the discounted value o

products (up to $450) rather than a reund and will be subject to a restocking ee.

Please initial here ________ to acknowledge that you have read and agr

to the above Terms of Agreement. Your application is not complete unless

initial this page and submit with your Independent Distributor Application


5/6

Product Order Form1607 E Big Beaver Rd Suite #110, Tr, M

Custmer Service 1.877.V

Fax Form To: 877.547

2011 ViSalus Sciences All Rights Reserved. Revised D1001US-

ITEM No. pRoDUCT DESCRIpTIoN WHoLESALE RETAIL qTy ToTAL AUTo-SHIp

K0020 Body by Vi Balance Kit $49 $61 5TH 12TH 1

K0021 Body by Vi Shape Kit $99 $124 5TH 12TH 1

K0019 Body by Vi Core Kit $199 $249 5TH 12TH 1

K0015 Body by Vi Transormation Kit $249 $311 5TH 12TH 1

Add Vi-pak to your Challenge Kit (Auto-Ship only) $99 n/a 5TH 12TH 1

N1210 Vi-Shape Nutritional Shake Mix (30 Serving Pouch) $45 $59 5TH 12TH 1

N1211 Vi-Shape Nutritional Shake Mix (15 Individual Packets) $28 $35 5TH 12TH 1

N1227 Nutra-Cookie Chocolate Chip (14 Individually Wrapped Cookies) $34 $41 5TH 12TH 1

N1228 Nutra-Cookie Oatmeal Raisin (14 Individually Wrapped Cookies) $34 $41 5TH 12TH 1

K0029 Nutra-Cookie Chocolate Chip 4-Pack (4 boxes) $125 $150 5TH 12TH 1

K0030 Nutra-Cookie Oatmeal Raisin 4-Pack (4 boxes) $125 $150 5TH 12TH 1

K0028 Nutra-Cookie Variety 4-Pack (2 boxes each Chocolate Chip and Oatmeal Raisin) $125 $150 5TH 12TH 1

N1212 Vi-Slim Metab-Awake! Tablets (60 Tablets per Bottle) $40 $50 5TH 12TH 1

N1213 Vi-Trim Clear Control Drink Mix (30 Individual Packets) $40 $50 5TH 12TH 1

N1214 Shape-Up Health Flavor Mix-In Strawberry (15 Individual Packets) $10 $12.50 5TH 12TH 1

N1215 Shape-Up Health Flavor Mix-In Chocolate (15 Individual Packets) $10 $12.50 5TH 12TH 1

N1216 Shape-Up Health Flavor Mix-In Banana (15 Individual Packets) $12 $15 5TH 12TH 1

N1217 Shape-Up Health Flavor Mix-In Peach (15 Individual Packets) $12 $15 5TH

12TH

1N1218 Shape-Up Health Flavor Mix-In Orange (15 Individual Packets) $12 $15 5

TH 12TH 1

K0010 Health Flavor Mix-In Variety 5Pack (1 box o each favor) $50 $63 5TH 12TH 1

N1002 Vi-pak(30 Daily AM/PM Packets) $125 $150 5TH 12TH 1

N1070 ViSalus NEURO Raspberry Boost Drink Mix (15 Packets) $24 $30 5TH 12TH 1

N1071 ViSalus NEURO Lemon Lit Drink Mix (15 Packets) $24 $30 5TH 12TH 1

N1077 ViSalus NEURO Raspberry Boost Drink Mix (25 Serving Jar) $38 $48 5TH 12TH 1

N1076 ViSalus NEURO Lemon Lit Drink Mix (25 Serving Jar) $38 $48 5TH 12TH 1

Side 1 Sub-Total

orm continues on reverse

Balance Kit $49$77 Retail Value Save $281 Pouch Vi-Shape Nutritional Shake Mix

5 Packets Shape-Up Health Flavor Mix-Ins

Core Kit $199$287 Retail Value Save $881 Vi-pak (30 daily AM/PM packets)

1 Pouch Vi-Shape Nutritional Shake Mix

5 Packets Shape-Up Health Flavor Mix Ins

2 Boxes ViSalus NEURO:

one each Raspberry Boost and Lemon Lit

Shape Kit $9$144 Retail Value Save $42 Pouches Vi-Shape Nutritional Shake Mix


Transformation Kit $24$349 Retail Value Save $102 Pouches Vi-Shape Nutritional Shake Mix


1 Bottle Vi-Slim Metab-Awake! Tablets

1 Box Vi-Trim Clear Control Drink Mix

1 Bottle Omega Vitals Supplement

2 Boxes ViSalus NEURO:

one each Raspberry Boost and Lemon Lit

Auto-Ship Price

Auto-Ship Price

Auto-Ship

Auto-Ship

Add the full Vi-pak to your

Challenge Kit(Auto-Ship Only) Only $99


6/6

Product Order Form1607 E Big Beaver Rd Suite #110, Tr, M

Custmer Service 1.877.V

Fax Form To: 877.547

2011 ViSalus Sciences All Rights Reserved. Revised D1001US-

Choose the Auto-Ship Program to guarantee you never run out of product.

Initial orders will be processed and shipped upon receipt.

Auto-Ship orders will be processed & shipped starting next month on the selected date.

Auto-Ship orders will be processed on the last business day before a weekend or holiday.

Changes to Auto-Ship orders must be received at least 5 days prior to Auto-Ship date. Customers who select Auto-Ship are Preferred and can receive Wholesale pricing.

ViSalus Aut-Shi Advantage prgram

ITEM No. pRoDUCT DESCRIpTIoN WHoLESALE RETAIL qTy ToTAL AUTo-SHIp

N1221 Anti-Aging & Energy Supplement (30 Capsules per Bottle) $44 $55 5TH 12TH

N1222 Supercharged Antioxidant Supplement (30 Tablets per Bottle) $34 $42.50 5TH 12TH

N1223 Multi Mineral & Vitamin Supplement (60 Tablets per Bottle) $24 $30 5TH 12TH

N1224 Omega Vitals Supplement (60 Sotgels per Bottle) $34 $42.50 5TH 12TH

N1220 Deter-Mints

Wintergreen (30 Chewable Tablets per Bottle) $25 $31.25

5

TH

12

TH

N1050 Vimmunity $28 $35 5TH 12TH

T2015 BBV Shaker Cup $9 $9

T2016 BBV Tape Measure $5 $5

T2017 BBV Pedometer $7 $7

T2018 BBV Shaker Cup / Program Guide / Journal Combo $10 $10

T2019 BBV Shaker Cup / Tape Measure / Pedometer Combo $19 $19

Side 1

Total Check one date for each indi

product you would like AuShipped to you each monDate Ordered: / /

NOTE: Tax and Shipping & Handling will be added to total.

Custmer Shiing Infrmatin


hipping Address: __________________________________________________

pt/Suite: ______________________________________________________

ty: ___________________________ State: ______ Zip: ______________

aytime Phone #: __________________________________________________

-mail Address: ___________________________________________________

Yes, I would like to receive communications from ViSalus regarding special discountsand promotions.

ll in the Name and I D number o the ViSalus Customer or Distributor signing you up today:


D # or SSN: ______________________________________________________

Custmer Billing Infrmatin

Full Name on Credit Card: _________________________________ __________

Billing Address: _________________________________________________

Apt/Suite: ____________________________________________________

City: ___________________________ State: ______ Zip: ____________

Credit Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|_

Expiration Date: ____________________ Security Code: __________________

Card Type: Visa MasterCard Discover American Express

Cardholder Signature: _____________________________________________

I authorize ViSalus Sciences to charge my account or the amount listed. I promise to pay such amount to a

in agreement governing the use o such card. I understand that ViSalus Sciences will apply Taxes, Shipping

and Handling charges to my order. I order is Autoship, I authorize ViSalus to ship these products monthly.

Cancellations must be submitted 5 days prior to the Auto-Ship date.

Retail Price: Price or customers who want the product one time.

Distributor Wholesale Price:Price or distributors and Auto-Ship Advantage Program customers.

*Please note: it is against ViSalus policy to sell any ViSalus product below its wholesale price.

See www.visalus.com or up-to-date product inormation and additional items.

Fax Order to 1.877.547.1570, call 1.877.VISALUS,

or place order online at www.visalus.com

SHIPPING SCALE

Order Total Shipping

From To

$0 $0.99 . . . . . . . . . $0$0.99 $50.00 . . . . . . . . $6

$50.01 $150.00 . . . . . . . $10


From To

$150.01 $300.00 . . . . . . . $14$300.01 $500.00 . . . . . . . $19

$500.01 $2489.99 . . . . . . $25


From To

$2490.00 $4989.99 . . . . . . $50$4990.00 $9989.99 . . . . . . $80

$9990.00 . . . . . . . . . . . $125

Enrollment Documents

Documents

Transcript of Enrollment Documents