AUS Member Discount Automatic Order Form
AUS Member Discount Automatic Order Form How to order
SM
By fax only:
Account Number
Fax this completed form to:
1300 361 828
First Name(s)
include credit card information with your order. If ordering by fax, DO NOT fax twice or mail hard copy of order to Mannatech.
By email only:
Scan and email this form to:
Ship to Information
[email protected]
First Name(s)
include credit card information with your order. If ordering by email, DO NOT fax or mail hard copy of order to Mannatech.
By mail only:
Send this completed form with credit card information to: MANNATECH SWISS INTERNATIONAL GMBH, C/- MANNATECH AUSTRALIA PTY LTD, LOCKED BAG 5000, ST LEONARDS, NSW 2065. AUSTRALIA Notice: Product orders are not binding until accepted on behalf of Mannatech Swiss International Gmbh In Coppell, Texas, USA
Surname
Surname Business Name Street Address
Suburb or Town State
Post Code
Country
A U S
Day Telephone
(
)
Mobile Telephone
( 04
)
Payment Information (please complete and sign.) Credit Card Number
Expiry Date
MM CCV
Y Y
The Card Code Verification (CCV) is an extra code printed on your debit or credit card. CCV for Visa and MasterCard is the final three digits of the number printed on the signature strip on the back of your card. CCV for American Express appears as a separate 4-digit code printed on the front of your card. The CCV is not embossed.
Cardholder Name Day Telephone
(
)
Cardholder Billing Address X Cardholder Signature
Date
AUTHORISATION – YOUR SIGNATURE IS REQUIRED I understand the Automatic Order will continue until Mannatech receives either my written notification or my verbal notification, by calling 1300 361 878 or showing either termination or a change in the order.
FOR OFFICE USE ONLY batch
payment id
____________________
order
# _______________
_____________________
___________ of ___________ __________________________
X
s i g n at u r e
NOTE: Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorisation 10 business days. Mannatech will charge a $22 fee for insufficient bank account balances. NOTICE: Product orders are not binding until accepted by Mannatech, Mannatech Swiss International GmbH.
ALL PRICES IN AUSTRALIAN DOLLARS & INCLUDE GST SUBSTITUTIONS AND/OR CHANGES CAN BE MADE WITHOUT NOTICE.
PAGE 1 of 2 UPDATED BP9 2012
AUS Member Discount Automatic Order Form IMPORTANT:
SM
If you do not indicate the date you would like your order to commence (top left of this page) the order will be processed on the date the application is received and every month there after until further notice.
Account Number Order to Commence:
D D M M Y Y 10% MEMBER AO (AUD $)
CODE
PRODUCT DESCRIPTION
12702
AMBROTOSE AO®
60 capsules
58.90
13002
AMBROTOSE AO®
240 capsules
193.90
35302
AMBROTOSE® COMPLEX
75g powder
104.60
37702
ADVANCED AMBROTOSE® with β-Carotene/Undaria
120 capsules
61.05
37502
ADVANCED AMBROTOSE® with β-Carotene/Undaria
75g powder
104.90
37602
ADVANCED AMBROTOSE® with β-Carotene/Undaria
150g powder
194.20
23002
BOUNCEBACK®
60 capsules
58.45
12002
CATALYST®
120 tablets
66.65
19302
EM•PACT Pre Workout Sports Drink®
360g powder
51.25
17102
EMPRIZONE®
142g gel
46.65
16602
OMEGA-3 WITH VITAMIN 3D
60 capsules
40.80
36202
GI-PRO BALANCE™
30 slim sticks
31.45
11502
GLYCOSLIM® DRINK MIX Chocolate
600g powder
54.85
11602
GLYCOSLIM® DRINK MIX Vanilla
600g powder
54.85
12302
IMMUNOSTART®
60 tablets
52.05
13502
MANNA•BEARS®
300g bears
26.10
39102
MANNA-C®
60 capsules
51.25
34302
NUTRIVERUS™
150g powder
74.95
22202
OSOLEAN®
2x366g powder
124.80
15102
PHYT•ALOE®
60 capsules
51.25
12802
PHYTOBURST® NUTRITIONAL CHEWS
11202
PHYTOMATRIX®
11102 12102
72302
NUTRIVERUS WEIGHT MANAGEMENT AUTOMATIC ORDER KIT FREE SHIPPING
1x 34302 2x 22002
199.75
72902
NUTRIVERUS 75G ADVANCED AMBROTOSE AUTOMATIC ORDER KIT - FREE SHIPPING
1x 34302 1x 37502
179.55
72802
NUTRIVERUS 150G ADVANCED AMBROTOSE AUTOMATIC ORDER KIT - FREE SHIPPING
1x 34302 1x 37602
269.15
72702
NUTRIVERUS AMBROTOSE COMPLEX AUTOMATIC ORDER KIT FREE SHIPPING
72502
NUTRIVERUS OPTIMAL HEALTH AUTOMATIC ORDER KIT FREE SHIPPING
72602
NUTRIVERUS FAMILY AUTOMATIC ORDER KIT -FREE SHIPPING
72402
NUTRIVERUS SPORT AUTOMATIC ORDER KIT -FREE SHIPPING
74002
NUTRIVERUS ESSENTIALS AUTOMATIC ORDER KIT - FREE SHIPPING
34302
NUTRIVERUS AUTOMATIC ORDER KIT -FREE SHIPPING
60 chews
42.17
120 tablets
66.65
PLUS™
90 tablets
51.25
SPORT WITH AMBROTOSE®
60 capsules
42.65
1x 34302 1x 35302 1x 34302 1x 16602 1x 11102 1x 34302 2x 13502 1x 16602 1x 34302 1x 12102 1x 19302 1x 34302 1x 16602 1x 36202 2x 34302
QTY
SUBTOTAL
179.55 167.00 167.95 168.85 137.25 149.90
TOTAL VALUE ON SELECTED PRODUCTS $ SHIPPING $
TOTAL $ ALL PRICES IN AUSTRALIAN DOLLARS & INCLUDE GST SUBSTITUTIONS AND/OR CHANGES CAN BE MADE WITHOUT NOTICE.
PAGE 2 of 2 UPDATED BP9 2012
10.45 (MAX)
SM
By fax only:
Account Number
Fax this completed form to:
1300 361 828
First Name(s)
include credit card information with your order. If ordering by fax, DO NOT fax twice or mail hard copy of order to Mannatech.
By email only:
Scan and email this form to:
Ship to Information
[email protected]
First Name(s)
include credit card information with your order. If ordering by email, DO NOT fax or mail hard copy of order to Mannatech.
By mail only:
Send this completed form with credit card information to: MANNATECH SWISS INTERNATIONAL GMBH, C/- MANNATECH AUSTRALIA PTY LTD, LOCKED BAG 5000, ST LEONARDS, NSW 2065. AUSTRALIA Notice: Product orders are not binding until accepted on behalf of Mannatech Swiss International Gmbh In Coppell, Texas, USA
Surname
Surname Business Name Street Address
Suburb or Town State
Post Code
Country
A U S
Day Telephone
(
)
Mobile Telephone
( 04
)
Payment Information (please complete and sign.) Credit Card Number
Expiry Date
MM CCV
Y Y
The Card Code Verification (CCV) is an extra code printed on your debit or credit card. CCV for Visa and MasterCard is the final three digits of the number printed on the signature strip on the back of your card. CCV for American Express appears as a separate 4-digit code printed on the front of your card. The CCV is not embossed.
Cardholder Name Day Telephone
(
)
Cardholder Billing Address X Cardholder Signature
Date
AUTHORISATION – YOUR SIGNATURE IS REQUIRED I understand the Automatic Order will continue until Mannatech receives either my written notification or my verbal notification, by calling 1300 361 878 or showing either termination or a change in the order.
FOR OFFICE USE ONLY batch
payment id
____________________
order
# _______________
_____________________
___________ of ___________ __________________________
X
s i g n at u r e
NOTE: Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorisation 10 business days. Mannatech will charge a $22 fee for insufficient bank account balances. NOTICE: Product orders are not binding until accepted by Mannatech, Mannatech Swiss International GmbH.
ALL PRICES IN AUSTRALIAN DOLLARS & INCLUDE GST SUBSTITUTIONS AND/OR CHANGES CAN BE MADE WITHOUT NOTICE.
PAGE 1 of 2 UPDATED BP9 2012
AUS Member Discount Automatic Order Form IMPORTANT:
SM
If you do not indicate the date you would like your order to commence (top left of this page) the order will be processed on the date the application is received and every month there after until further notice.
Account Number Order to Commence:
D D M M Y Y 10% MEMBER AO (AUD $)
CODE
PRODUCT DESCRIPTION
12702
AMBROTOSE AO®
60 capsules
58.90
13002
AMBROTOSE AO®
240 capsules
193.90
35302
AMBROTOSE® COMPLEX
75g powder
104.60
37702
ADVANCED AMBROTOSE® with β-Carotene/Undaria
120 capsules
61.05
37502
ADVANCED AMBROTOSE® with β-Carotene/Undaria
75g powder
104.90
37602
ADVANCED AMBROTOSE® with β-Carotene/Undaria
150g powder
194.20
23002
BOUNCEBACK®
60 capsules
58.45
12002
CATALYST®
120 tablets
66.65
19302
EM•PACT Pre Workout Sports Drink®
360g powder
51.25
17102
EMPRIZONE®
142g gel
46.65
16602
OMEGA-3 WITH VITAMIN 3D
60 capsules
40.80
36202
GI-PRO BALANCE™
30 slim sticks
31.45
11502
GLYCOSLIM® DRINK MIX Chocolate
600g powder
54.85
11602
GLYCOSLIM® DRINK MIX Vanilla
600g powder
54.85
12302
IMMUNOSTART®
60 tablets
52.05
13502
MANNA•BEARS®
300g bears
26.10
39102
MANNA-C®
60 capsules
51.25
34302
NUTRIVERUS™
150g powder
74.95
22202
OSOLEAN®
2x366g powder
124.80
15102
PHYT•ALOE®
60 capsules
51.25
12802
PHYTOBURST® NUTRITIONAL CHEWS
11202
PHYTOMATRIX®
11102 12102
72302
NUTRIVERUS WEIGHT MANAGEMENT AUTOMATIC ORDER KIT FREE SHIPPING
1x 34302 2x 22002
199.75
72902
NUTRIVERUS 75G ADVANCED AMBROTOSE AUTOMATIC ORDER KIT - FREE SHIPPING
1x 34302 1x 37502
179.55
72802
NUTRIVERUS 150G ADVANCED AMBROTOSE AUTOMATIC ORDER KIT - FREE SHIPPING
1x 34302 1x 37602
269.15
72702
NUTRIVERUS AMBROTOSE COMPLEX AUTOMATIC ORDER KIT FREE SHIPPING
72502
NUTRIVERUS OPTIMAL HEALTH AUTOMATIC ORDER KIT FREE SHIPPING
72602
NUTRIVERUS FAMILY AUTOMATIC ORDER KIT -FREE SHIPPING
72402
NUTRIVERUS SPORT AUTOMATIC ORDER KIT -FREE SHIPPING
74002
NUTRIVERUS ESSENTIALS AUTOMATIC ORDER KIT - FREE SHIPPING
34302
NUTRIVERUS AUTOMATIC ORDER KIT -FREE SHIPPING
60 chews
42.17
120 tablets
66.65
PLUS™
90 tablets
51.25
SPORT WITH AMBROTOSE®
60 capsules
42.65
1x 34302 1x 35302 1x 34302 1x 16602 1x 11102 1x 34302 2x 13502 1x 16602 1x 34302 1x 12102 1x 19302 1x 34302 1x 16602 1x 36202 2x 34302
QTY
SUBTOTAL
179.55 167.00 167.95 168.85 137.25 149.90
TOTAL VALUE ON SELECTED PRODUCTS $ SHIPPING $
TOTAL $ ALL PRICES IN AUSTRALIAN DOLLARS & INCLUDE GST SUBSTITUTIONS AND/OR CHANGES CAN BE MADE WITHOUT NOTICE.
PAGE 2 of 2 UPDATED BP9 2012
10.45 (MAX)
