NEW DISTRIBUTOR WORK SHEET

(worksheet form only for printing - not set up for on-line registration - email or call me to register.)

Date:_______________________New Assigned ID. #____________________________________

New Distributor's S.S #______________________________________________________
(Social Security # or Canadian Social Insurance #)
New Distributor's name:_____________________________________________________________
Mailing address:___________________________________________________________
______________________________________________________________________
______________________________________________________________________
                                                                                                            Best Times To Call
Home phone:__________________________________________
Work phone:__________________________________________
Fax number:___________________________________________
Email:________________________________________________

UPS Shipping address: (If different from mailing address. Packages cannot be shipped to PO Box#'s)
______________________________________________________________________
______________________________________________________________________

Sponsors Name:_____Patricia E. Murphy_________ID#:____211380________________
Address:_________________________________________________________________________
Phone #'s:_____530-472-3237_______Toll Free:__ 1-877-508-8845_____________________________

Order (Use code numbers):________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________ caps_____ tablets_____ liquid flavor_____ powder_____

Credit Card # (MC/VISA/DISCOVER)
_______________________________________________________exp._____________
Name on card:______________________________________________________________________
Order #___________________________________________approved_______________
Shipping: Ground UPS________ 2 Day________ Next Day_______Other______________
Initial Order:___________________________ Bonus Value:________________________
Personal Notes: (Family members, health concerns, interests, dreams)
© 1994 2007 Pat Murphy, All Rights Reserved. Personal information will be kept confidential.

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