Application Form -Associate -
Application Form -Associate 1
Join the Mannatech Family
2
Associate Information
ACCOUNT NUM B E R:
CURP REQUIR ED FOR IND IVIDUALS :
RFC REQUIR ED FOR BUSINESSES & INDIVIDUALS EARNING BONUSES
SPONSOR INFORMATION
Choose your Associate Pack.* (Please check only one.)
LAST NAMES
All Star Advanced Ambrotose Pack
11225
$3,800
All Star Custom Pack
112525
$3,800
MUST BE FILLED OUT PRIOR TO SUBMISSION TO MANNATECH. ACCOUNT NUMBER FIRST NAME NAME IS REQUIRED FOR PROCESSING COUNTRY_________________ LAST NAMES
Preferred Wellness Pack
133925
$1,720
Preferred Chocolate Pack
133325
$1,720
Preferred Vanilla Pack
133425
$1,720
Preferred NutriVerus Pack
135225
$1,720
B a s i c R e g i s t r a t i o n Pa c k
135525
BUSINESS NAME SOLE PROPRIETORSHIP TRUST PARTNERSHIP CORPORATION PLEASE NOTE: If trust, corporation or partnership account, the deed of incorporation and power of attorney evidencing signature authority must accompany this application. FIRST NAME
“MAIN ADDE SS ” INFORMATION ENROLLER INFORMATION
$599
CITY
STATE
Applicant Pack Option Price
TELEPHONE
DAYTIME
3
‡ MONTH DAY YEAR
-
EVENING EVENING TELEPHONE
EMAIL ADDRESS PLEASE PRINT
Payment Information
Automatic Order RETAIL PRICE
QTY
PLEASE COMPLETE AND SIGN
4
NOTE: For your protection, Mannatech reserves the right to hold credit card orders for address verification. Declined credit card orders will be held for authorization for 10 business days. If we are unable to obtain an authorization we will cancel the order.
TOTAL
CASH MASTERCARD
IF DIFFERENT FROM “Main Address” EXTERIOR NUMBER
INTERIOR NUMBER
®
CITY
STATE
DELEGATION
Authorization
DISCOUNT
-
EXP. DATE
FREE
YOUR AUTOMATIC ORDER TOTAL =
POSTAL CODE
ACCOUNTHOLDER SIGNATURE
I understand that the Associate Automatic Order is optional and will continue until the Mannatech corporate o ce receives either my written or verbal noti cation, by calling 01 800 00 MANNA, requesting cancellation.
5
YOUR SIGNATURE IS REQUIRED
By signing below I apply to become an independent commerical distributor ("Associate") with MTEX México S. de R. L. de C. V. and Mannatech Swiss International GmbH, and agree to abide by the terms and conditions as stated on the present Associates Contract.
X
Order shipped and charged every 4 weeks. Credit card and checking account withdrawal only.
DATE
ACCOUNTHOLDER NAME PRINTED
X___________________________________________________________________ DATE
ACCOUNTHOLDER BILLING ADDRESS
NOTE: All prices include IVA. © 2011 Mannatech, Incorporated
“SHIP TO” INFORMATION
STREET
CREDIT CARD NUMBER
SUBTOTAL
SIGNATURE OF APPLICANT
_______________________________________________________________________________________________
DISTRICT
VISA®
If applicant is interested in having payment for Automatic Order debited from a checking account, please complete a Direct Debit Form (see MOD 2801725) and mail with this Application.
AUTOMATIC ORDER SHIPPING & HANDLING
POSTAL CODE
DAY TELEPHONE
I ATION TOTALAMOUNT DUE WITHAPPLC
SINGLE PRODUCT DESCRIPTION
DELEGATION
FIRST NAME
$70
Shipping & Handling
CODE
DISTRICT
LAST NAMES
*See instructions page of this form for details on these packs.
Please bill and ship my Automatic Order beginning:
INTERIOR NUMBER
ACCOUNT NUMBER
COUNTRY_________________
Yes, I want to receive free shipping!
EXTERIOR NUMBER
STREET
The Enroller and Sponsor may be the same person, or the Enroller may place the new Associate under another Sponsor in his/her sales organization. Neither the Sponsor nor the Enroller receives any bonus, payment or other ben t from the recommendation of a new Associate.
CITY
White: Mannatech Original
STATE
ZIP
Yellow: Associate
X________________________________________________________________ SIGNATURE OF APPLICANT
Blue: Person Registering
DATE
2801525.01242011 Page 2 of 3
Join the Mannatech Family
2
Associate Information
ACCOUNT NUM B E R:
CURP REQUIR ED FOR IND IVIDUALS :
RFC REQUIR ED FOR BUSINESSES & INDIVIDUALS EARNING BONUSES
SPONSOR INFORMATION
Choose your Associate Pack.* (Please check only one.)
LAST NAMES
All Star Advanced Ambrotose Pack
11225
$3,800
All Star Custom Pack
112525
$3,800
MUST BE FILLED OUT PRIOR TO SUBMISSION TO MANNATECH. ACCOUNT NUMBER FIRST NAME NAME IS REQUIRED FOR PROCESSING COUNTRY_________________ LAST NAMES
Preferred Wellness Pack
133925
$1,720
Preferred Chocolate Pack
133325
$1,720
Preferred Vanilla Pack
133425
$1,720
Preferred NutriVerus Pack
135225
$1,720
B a s i c R e g i s t r a t i o n Pa c k
135525
BUSINESS NAME SOLE PROPRIETORSHIP TRUST PARTNERSHIP CORPORATION PLEASE NOTE: If trust, corporation or partnership account, the deed of incorporation and power of attorney evidencing signature authority must accompany this application. FIRST NAME
“MAIN ADDE SS ” INFORMATION ENROLLER INFORMATION
$599
CITY
STATE
Applicant Pack Option Price
TELEPHONE
DAYTIME
3
‡ MONTH DAY YEAR
-
EVENING EVENING TELEPHONE
EMAIL ADDRESS PLEASE PRINT
Payment Information
Automatic Order RETAIL PRICE
QTY
PLEASE COMPLETE AND SIGN
4
NOTE: For your protection, Mannatech reserves the right to hold credit card orders for address verification. Declined credit card orders will be held for authorization for 10 business days. If we are unable to obtain an authorization we will cancel the order.
TOTAL
CASH MASTERCARD
IF DIFFERENT FROM “Main Address” EXTERIOR NUMBER
INTERIOR NUMBER
®
CITY
STATE
DELEGATION
Authorization
DISCOUNT
-
EXP. DATE
FREE
YOUR AUTOMATIC ORDER TOTAL =
POSTAL CODE
ACCOUNTHOLDER SIGNATURE
I understand that the Associate Automatic Order is optional and will continue until the Mannatech corporate o ce receives either my written or verbal noti cation, by calling 01 800 00 MANNA, requesting cancellation.
5
YOUR SIGNATURE IS REQUIRED
By signing below I apply to become an independent commerical distributor ("Associate") with MTEX México S. de R. L. de C. V. and Mannatech Swiss International GmbH, and agree to abide by the terms and conditions as stated on the present Associates Contract.
X
Order shipped and charged every 4 weeks. Credit card and checking account withdrawal only.
DATE
ACCOUNTHOLDER NAME PRINTED
X___________________________________________________________________ DATE
ACCOUNTHOLDER BILLING ADDRESS
NOTE: All prices include IVA. © 2011 Mannatech, Incorporated
“SHIP TO” INFORMATION
STREET
CREDIT CARD NUMBER
SUBTOTAL
SIGNATURE OF APPLICANT
_______________________________________________________________________________________________
DISTRICT
VISA®
If applicant is interested in having payment for Automatic Order debited from a checking account, please complete a Direct Debit Form (see MOD 2801725) and mail with this Application.
AUTOMATIC ORDER SHIPPING & HANDLING
POSTAL CODE
DAY TELEPHONE
I ATION TOTALAMOUNT DUE WITHAPPLC
SINGLE PRODUCT DESCRIPTION
DELEGATION
FIRST NAME
$70
Shipping & Handling
CODE
DISTRICT
LAST NAMES
*See instructions page of this form for details on these packs.
Please bill and ship my Automatic Order beginning:
INTERIOR NUMBER
ACCOUNT NUMBER
COUNTRY_________________
Yes, I want to receive free shipping!
EXTERIOR NUMBER
STREET
The Enroller and Sponsor may be the same person, or the Enroller may place the new Associate under another Sponsor in his/her sales organization. Neither the Sponsor nor the Enroller receives any bonus, payment or other ben t from the recommendation of a new Associate.
CITY
White: Mannatech Original
STATE
ZIP
Yellow: Associate
X________________________________________________________________ SIGNATURE OF APPLICANT
Blue: Person Registering
DATE
2801525.01242011 Page 2 of 3
