Preferred Customer Application - Support...
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Preferred Customer Application Payment Method Visa MasterCard Discover _________________________________________ Card Number _________ /____________ __________________ EXP. (MO/Year) Security Code _________________________________________ Name on Card _________________________________________ Billing Address _____________________ ______ ___________ City ST/Prov. Zip/Postal Code _________________________________________ Signature of Cardholder Referral Website Information Choose a name for your branded Nerium referral website Example: www.yourname.neriumproducts.com __________________________________ __________________________________ Option 1 Option 2 This will also be your username for logging in to your personal account. Retail customers will use your email address to place orders. Choose a Password ______________________________________________________________________________________ Password must consist of letters or numbers only. Must be 4-15 characters in length. Take advantage of our 3UR Free program. Simply sign up three active Preferred Customers in the Auto-Delivery Order program, and you’ll get your next month’s Auto-Delivery Order of NeriumAD Age-Defying Treatment for free! I authorize Nerium International ™ to charge the above named account for the purchase option selected. I understand that Nerium International will apply applicable taxes and shipping and handling charges to my order. An Auto-Delivery Order is included in this purchase option. I authorize Nerium International to ship/charge for these products monthly. Cancellation must be submitted in writing at least five (5) business days prior to the Auto-Delivery billing cycle date. I understand that all financial transactions are in US Dollars. Preferred Customer Signature: ______________________________________________________ Date: ____________________________________ All signatures to this application must be affixed personally. Applicants must be of legal age. I would like to become a Nerium International Preferred Customer and receive my product every month at a discounted price. Shipping and handling and applicable sales tax will be added to my total order at the time it is processed. Please enroll me in the Auto-Delivery Order Program. My Auto-Delivery Order will be processed and shipped starting next month, on the same day of the month that this original order is processed. If that day falls on a weekend or holiday, the order will be processed on the last business day prior. The payment method used for my initial enrollment will be used for my Auto-Delivery Order. The product order I receive will be shipped monthly. Signature: ____________________________________________________________________ Save $30-45 USD per order as a Preferred Customer! Fax to: 214.390.9988 ©2013 Nerium International ™ , LLC. All Rights Reserved. Revised 9/13. Who Introduced You to Nerium? ______________________________________________________________________________________ Nerium ID Number or Username _______________________________________________ _____________________________ _______ Name (First, Last) City ST/Prov Personal Information _____________________________________________________________________ _______________ Name (Last, First, Middle) Date of Birth (optional) ______________________________________________________________________________________ Business Name (if applicable) ______________________________________________________________________________________ Shipping Address (Must be a physical address. Cannot ship to a P. O. Box) _______________________________________________ _______ ________________ __________ City ST/Prov Zip/Postal Code Country __________________________________________ __________________________________________ Email Phone Number (check one: cell home) Purchase Product Quantity Description Auto-Delivery Preferred Customer Price: Total NeriumAD Age-Defying Treatment $80/Bottle of night cream NeriumAD Combo Pack $120/Pack of day and night cream NeriumAD ® Age-Defying Treatment NeriumAD products are developed from the patented extract of the Nerium oleander plant. They contain the most effective age-defying ingredients, chosen for both their individual and synergistic benefits. These premium ingredients are blended at optimum levels to nourish your skin and provide real results.
Transcript of Preferred Customer Application - Support...
Preferred Customer Appl icat ion
Payment Method
Visa MasterCard Discover
_________________________________________
Card Number
_________ /____________ __________________
EXP. (MO/Year) Security Code
_________________________________________
Name on Card
_________________________________________
Billing Address
_____________________ ______ ___________
City ST/Prov. Zip/Postal Code
_________________________________________
Signature of Cardholder
Referral Website Information Choose a name for your branded Nerium referral websiteExample: www.yourname.neriumproducts.com
__________________________________ __________________________________ Option 1 Option 2
This will also be your username for logging in to your personal account. Retail customers will use your email address to place orders.
Choose a Password
______________________________________________________________________________________
Password must consist of letters or numbers only. Must be 4-15 characters in length.
Take advantage of our 3UR Free program. Simply sign up three active Preferred Customers in the Auto-Delivery Order program, and you’ll get your next month’s Auto-Delivery Order of NeriumAD Age-Defying Treatment for free!
I authorize Nerium International™ to charge the above named account for the purchase option selected. I understand that Nerium International will apply applicable taxes and shipping and handling charges to my order. An Auto-Delivery Order is included in this purchase option. I authorize Nerium International to ship/charge for these products monthly. Cancellation must be submitted in writing at least five (5) business days prior to the Auto-Delivery billing cycle date. I understand that all financial transactions are in US Dollars.
Preferred Customer Signature: ______________________________________________________ Date: ____________________________________All signatures to this application must be affixed personally. Applicants must be of legal age.
I would like to become a Nerium International Preferred Customer and receive my product every month at a discounted price.
Shipping and handling and applicable sales tax will be added to my total order at the time it is processed.
Please enroll me in the Auto-Delivery Order Program. My Auto-Delivery Order will be processed and shipped starting next month, on the same day of the month that this original order is processed. If that day falls on a weekend or holiday, the order will be processed on the last business day prior. The payment method used for my initial enrollment will be used for my Auto-Delivery Order. The product order I receive will be shipped monthly.
Signature: ____________________________________________________________________
Save $30-45 USD per order as a Preferred Customer!
Fax to: 214.390.9988
© 2 0 1 3 N e r i u m I n t e r n a t i o n a l ™, L L C . A l l R i g h t s R e s e r v e d . R e v i s e d 9 / 1 3 .
Who Introduced You to Nerium?______________________________________________________________________________________Nerium ID Number or Username_______________________________________________ _____________________________ _______ Name (First, Last) City ST/Prov
Personal Information_____________________________________________________________________ _______________Name (Last, First, Middle) Date of Birth (optional)
______________________________________________________________________________________Business Name (if applicable)
______________________________________________________________________________________Shipping Address (Must be a physical address. Cannot ship to a P. O. Box)_______________________________________________ _______ ________________ __________ City ST/Prov Zip/Postal Code Country__________________________________________ __________________________________________Email Phone Number (check one: cell home)
Purchase Product
Quantity Description Auto-Delivery Preferred Customer Price: Total
NeriumAD Age-Defying Treatment $80/Bottle of night cream
NeriumAD Combo Pack $120/Pack of day and night cream
NeriumAD® Age-Defying Treatment
NeriumAD products are developed from the patented extract of the Nerium oleander plant. They contain the most effective age-defying ingredients, chosen for both their individual and synergistic benefits. These premium ingredients are blended at optimum levels to nourish your skin and provide real results.
