APPLICANT'S INFORMATION

Surname

First name

Middle Name

Street Address
A value is required.
Town

Country

Postcode

Telephone:Day Telephone: Evening
Mobile

Click here if you would like to receive your information by email/internet

Email Address (if applicable)

Date of birth (day) Month (spelled out) Year Age

CO-APPLICANT'S INFORMATION (if applicable)

Spouse's Surname

First name

Middle Name

Street Address
A value is required.
Town

Country

Postcode

Telephone:Day Telephone: Evening
Mobile

NOTICE TO APPLICANT & SPONSOR

Previous distributorship either owned or operated by the applicant must be reported. If the mandatory period of inactivity as specified in rule 7-E (Rules of Conduct and Distributor Policies) has not been maintained, there may be serious ramifications to both the applicant/distributor and the sponsoring lineage. Herbalife will not be responsible for any losses that may occur as a result of misrepresentation of the information requested below. The applicant's signature on the final printed application certifies that the information stated below is true and correct.

COMPLETION OF THIS SECTION IS REQUIRED

Have you or your spouse previously been Herbalife Distributors or participated in any Herbalife Distributorship?
Please Check One: Yes No

If yes, please provide previous Distributorship ID Number / Name / Application Date (Applicants, if registering with a different Sponsor, must have at least one year of inactivity after non-payment of the Annual Processing Fee or registration of the previous distributorship)

ID Number Name
Application Date

ON COMPLETION OF THIS FORM

Your personal advisor will send a filled in form to you for signing. The termas and conditions will accompany this and by signing the form you have read and agreed to these.

If you sign the contract you have 14 days in which to cancel and get your money back.