Melaleuca Wellness Centre - Enrollment CA
Friday, Aug. 25, 2006
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Marco R Willis
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Online Enrolment Customer Agreement

A. Personal Details
First Name: * Surname: *
Greeting Name: *
Date of Birth:* mm/dd/yyyy
Home Phone Number:
(area code)
Business Phone Number:
(area code)
Mobile Number:
Fax Number:
(area code)
Email Address: *
Confirm Email Address: *
Preferred Contact Number:

B. Spouse/Partner Details (if applicable)
First Name:
Surname:
Greeting Name:
Date of Birth: mm/dd/yyyy

C. Business Details (if applicable)
ABN Number:

D. Shipping Address Details

Address Line 1: *
Address Line 2:
City: *
Post Code: *
State: *
Country: Australia
Delivery Instructions:

E. Mailing Address Details (if different from shipping details)
Address Line 1:
Address Line 2:
City: Post Code: State:
Country: Australia
Delivery Instructions:

F. Pay Method Details > Primary Credit Card

Pay Method Type:
Account Number:
Expiration Date:
mm
yy

G. Pay Method Details > Secondary Credit Card

Pay Method Type:
Account Number:
Expiration Date: mm yy

H. Pay Method Details > Australian Direct Debit Request

Financial Institution:
Branch:
Account Holder Name:
BSB (Branch No.) Account Number:


I/we authorise and request Melaleuca or Melaleuca APCA# 069489 to arrange for funds to be debited from my (our) account at the financial institution listed above as prescribed by the Bulk Electronic Clearing System (BECS) or the Electronic Data Service (EDS) as applicable. I (we) acknowledge that this Direct Debit arrangement is governed by the terms of the Authority to Accept
Direct Debits included in this Customer Agreement.


I. Customer Type


I commit to purchasing products totalling at least (select one)

55 Product Points each month and I am entitled to receive 30% to 40% off the regular price of Melaleuca products
I will pay the retail price with no monthly product point commitment

J. Enrolment Fee

Send me a Welcome Kit
AU$45/NZ$45 Enrolment Fee If you are also submitting an Independent Marketing Executive Application and Agreement (IMEA), your Customer enrolment fee is included in the $49 IMEA fee. (Tick one)
Send me my Melaleuca Membership Kit
The cost to enrol as a Marketing Executive is AU$49 and NZ$49, this also covers the Preferred Customer enrolment fee. Youll receive a Melaleuca Membership Kit and other literature, including a subscription to Melaleucas regular publications (Leadership in Action and Melaleuca Country Catalogue), to familiarise you with and keep you up to date on Melaleucas programs and products.

You will receive your Melaleuca Membership Kit with your first order, unless other wise specified.
. The number is:

K. Enroller (the person who introduced the customer to Melaleuca)

First Name: *
Initial:
Surname:*
Customer ID Number:
Phone Number:* (area code)

L. Presenter (the person who presented the Melaleuca opportunity to the customer)

ID Number:
Name of Presenter:

M. Marketing Executive

First Name:*
Initial:
Surname:*
Customer ID Number:
Phone Number:
(area code)

N. Preferred Customer Back Up Order

If youre away on holiday or business, dont meet your Product Point commitment, or just forget to place your order, the Backup Order will be sent automatically, assuring that you meet your Product Point commitment and that you receive all Preferred Customer savings and benefits. If no box is selected Preferred Customers will automatically receive either Backup Order #1 or #2 depending on their product point commitment. See the Melaleuca Backup Order Lineup and ask your enroller about your Product Point commitment level. Shipping and handling is not included in the prices listed below. Choose the Preferred Customer Backup Order that fits your needs.
Daily For Life (35PP) AU$94.95 / NZ$105.95

For Men


Standard Back Up Orders
#2 55 Product Points AU$154.50 / NZ$179.95

O. Select Pack Backup Order

Complete Section below
PRODUCT POINT COMMITMENT (Your Select-Pack Product Points must equal or exceed the commitment level selected below).
Select One

Commitment
Ticking one of these commitment levels entitles you to purchase any combination of Melaleuca products at Preferred Customer prices on your Select-Pack. You will be sent the Select-Pack Backup Order listed below any month that your total product purchases do not equal or exceed 35 or 55 Product Points. Note: You may change the items selected below at any time by contacting Melaleuca. Changes to your Product Point commitment require you to sign and submit a new Customer Agreement.
Please list all the products you would like in your Select Pack . Type in SKU# and Quantity (ex. 117.1 to include a single Gold Bar) or Product Name and Quantity (ex. The Gold Bar.2 to include 2 Gold Bars). Please ensure that the total Product Points are equal to or greater than the product point commitment selected.

*Shipping and Handling will be added to your order and reflected in the printed invoice included.
 Total PPs
Total Price
P. Agreement
I ACKNOWLEDGE THAT I AM 18 YEARS OF AGE OR OLDER AND
I HAVE CAREFULLY READ AND AGREE TO THE MELALEUCA CUSTOMER AGREEMENT TERMS AND CONDITIONS.
I acknowledge that I have been given the opportunity to review and agree to be bound by the terms and conditions of Melaleucas privacy statement and Statement of Policies.
By accepting below, I am offering to become a Melaleuca Customer. I acknowledge that this agreement will not become effective until it is accepted by Melaleuca. *
Applicant's Confirmation> This Agreement is not valid unless ticked *
Co-applicant's confirmation (optional)

I may cancel this Agreement for any reason by giving written notice to Melaleuca bearing my original signature, printed name, address and ID Number. Written cancellations received by Melaleuca on or before the 25th of the month will be effective the month received. Written cancellations received by Melaleuca after the 25th of the month will be effective the following month. Cancellation notices must be mailed (not faxed or emailed) to: Melaleuca of Australia and New Zealand Pty Ltd, Locked Bag 2080, Somerton VIC, Australia 3062 or Private Bag 94022, South Auckland Mail Centre, Manukau City, New Zealand.

See Termination Provision for further details.


Q. Customer's First Order (optional)

Please list all the products you would like in your First Order. Type in SKU# and Quantity (ex. 117.1 to include a single Gold Bar) or Product Name and Quantity (ex. The Gold Bar.2 to include 2 Gold Bars). Please ensure that the total Product Points are equal to or greater than the product point commitment selected.
*Shipping and Handling will be added to your order and reflected in the printed invoice included.
 Total PPs
Total Price

As per Melaleuca's terms and conditions please print a copy of your enrolment and submit at your earliest convenience. This information will be required if you wish to make any further alterations.

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