INDEPENDENT BUSINESS OWNER

Fax To:

APPLICATION & AGREEMENT

(310) 878-9040

Mail to: 17909 S. Adria Maur Lane, Carson, CA 90746   Tel: 877-550-9600

   

 STEP1

   Social Security #, or Federal Tax ID#

   Home Phone Number

   Fax Number

   Work Phone Number
   Applicants Name (Last, First, M.I.) or Company Name
   Street Address
  City   State   Zip Code

Ship
To If
Different
From
Above
  Name  
  Street Address
  City   State   Zip Code

SPONSOR INFORMATION

               Current E-Mail:___david@davidbullock.net_________________
  Last Name (Sponsor)   First Name

A PARTICIPANT IN THIS MARKETING PROGRAM HAS   THE RIGHT TO CANCEL AT ANY TIME, REGARDLESS OF REASON. CANCELLATION MUST BE SUBMITTED IN WRITING TO THE COMPANY AT:
17909 S. Adria Maru Lane, CA 90746

Bullock

David
  Sponsor's ID#
145-56-0451

           APPLICANT SIGNATURE________________________________________             DATE___________   

STEP 2

ORDER FORM

WELLNESS PACKAGE A*
 $130 ($100 SV)

 1 -MSM 1000mg. - 400 Capsules
1 - MSM Lotion 8oz.
1 - Vitamin C - 100 Capsules
1 - MSM Drops
Literature & Audio Tapes

TOTAL FAMILY WELLNESS PACKAGE B*
$360 ($301 SV)
 2 - MSM 1000mg. - 400 Capsules
1 - MSM Lotion 8oz.
2 - Vitamin C - 100 Capsules
1 - MSM Drops
1 - Ultra Daily Multi Vitamins - 30 Day Supply
1 - Gingko Biloba Extract - 250 Capsules
1 - Grapeseed Extract - 120 Capsules
1 - Fresh & Clean MSM Toothpaste
Literature & Audio Tapes

Payment Method:

 *TAX, SHIPPING, HANDLING INCLUDED IN ALL PACKAGES

CASH      MONEY ORDER      CHECK       **EFT      VISA      M/C      AMEX     -     Circle Payment Method

**EFT - Electronic Fund Transfer (Attach or Fax Voided Check)

CC#

                          -                         -                         -   Exp Date

SIGNATURE______________________________

PRINT NAME________________________________

Card Holders Contact Number____________________________________

STEP 3

Please Send Package _____ on a regular automatic shipment. I will receive a FREE bottle of MSM 1000 - 200 capsules (a $35 value) every month with my autoship order of $100 SV or more. I understand I can cancel at anytime. 

1st week      2nd week      3rd week      4th week

 Circle week for delivery

Special Report | Compensation Plan