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Tell Us About Yourself
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Please Enter Your Personal Information
Begin your enrollment here by entering your name and address, along with you shipping information. For tax reporting purposes, you will also be prompted to enter your social security number. All required fields are indicated by
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Referred By
Jerri Smith
Name
●
Company Name
Shipping Address
Address
●
Country
●
Canada
Japan
Mexico - Mexico
Puerto Rico
United Kingdom - GREAT BRITAiN
United States
USA - America
City
●
State
●
[Select A State]
Alabama
Alaska - The Last Frontier
American Samoa (see also separate entry under AS)
APO
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam (see also separate entry under GU)
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Not Applicable
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico (see also separate entry under PR)
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
●
Contact Information
Phone
Email
●
Birthdate
Identification
SSN
Additional Information
Please provide the following additional information so we may set up your account correctly.
Agent License #
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Select Your Products
How would you like to enroll?
Select the rank and product you wish to enroll with. Once you select a product, the system will display an image and description of your selection.
Rank
[Select Rank]
Agent
Bronze
Silver
Product
[Select A Rank FIRST.]
Select a product in the list above. A description and image of the product will then appear in this area.
Automatic Shipment Setup
Make your selections for monthly shipment
Make your automatic shipment selections here. It will be clearly indicated if you are required to place a recurring order.
Monthly Qualification Autoship
The most important thing you can do for your business is enroll in autoship. One of the simple requirements to maintain earning potential is that distributors remain "Active". The best way to remain "Active" is to enroll in our autoship Program where your product will be sent to you automatically every month. "Active" status require a minimum of 120 PV.
[Select an Option]
Power Pak 1 - 25.00
Power Pak 2 - 225.00
Power Pak 3 - 125.00
Annual Renewal
(Selection Is Required)
By setting up your annual renewal on autoship, you will never have to worry about missing the deadline! Our system will take care of it for you. Just make a selection and we will take care of the rest.
[Select an Option]
Bronze Annual Renewal - 25.00
Silver Annual Renewal - 50.00
Gold Annual Renewal - 125.00
Enter Payment Information
Select A Payment Method
Enter your payment method below. Once this form is completed, you will be on your way to building a new and exciting business!
Order Totals
Product Sub-Total
$ 0.00
Discount Applied
$ 0.00
Shipping and Handling
$ 0.00
Country Specific Fees
$ 0.00
Sales Tax
$ 0.00
Gift Certificates Applied
$ 0.00
Total Amount Due
$ 0.00
Select A Shipment Method
Shipping Method
[Enter Address and Select Product First]
Have a Coupon? Apply it here
Enter Coupon Code
Apply Your Gift Certificates Here
Search by Serial Number
Payment Method
[Select A Payment Method]
American Express
Discover
Master Card
Visa Card
Electronic Check (Up to 3 Day Hold)
(use this for demo) CASH
Wire Transfer
No additional information is required
Billing Address (must match credit card)
Use shipping address
Name
Address
Country
[Select A Country]
Canada
Japan
Mexico - Mexico
Puerto Rico
United Kingdom - GREAT BRITAiN
United States
USA - America
City
State
[Select A State]
Alabama
Alaska - The Last Frontier
American Samoa (see also separate entry under AS)
APO
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam (see also separate entry under GU)
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Not Applicable
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico (see also separate entry under PR)
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Set up your Replicated Website
Select your website name and password
A Replicating website is an important part of your business. Choose a name that will be easy to remember! Your website name must be unique in our system and must not contain any spaces or special characters. An example of a correct website name is as follows:
http://www.companyname.com/YOURWEBSITENAMEHERE
Website Name
Enter A Password For Your Web Office
Password
Confirm
Complete Your Order
Final Confirmation
You are almost done! By clicking on the button below, your order will be processed and your enrollment will be completed. You will receive an email confirmation shortly with details of your order.
Terms And Conditions
Please click on the Download link below and read the terms and conditions document. Once you understand and agree to the terms outlined in this document, select the 'I Agree to the terms and conditions' checkbox below to continue.
Click Here To View Terms and Conditions
I Agree To The Terms and Conditions