Herbalife International Business Pack Order Form

You can fill this form out here and print it on your printer for faxing or mailing.

01/18/07
Fax to: +354 565 9019 (Remember! If you live outside Iceland this is a foreign fax number and you must dial for an International line.)

Or mail with Check or Credit Card information to:
Mr. Isleifur Gislason
Holtsbud 5
Gardabaer
Iceland, IS-210

I want to Join Herbalife as an Independent Distributor, so please send me one Herbalife International Business pack.
I understand that I will be billed for the price of the pack plus Shipping and Handling the amount of US $ 90.-

I am paying by (please check one): Check Credit card

(Please be aware that shipment will not be processed until you check or credit card has been cleared.)

Your Name: Your Phone number:

Street address: Your fax Number:

City: Your e-mail address:

State: Postal (Zip) Code:

Country:

If paying by Credit Card:

Credit Card Type (Visa, MasterCard, etc.):

Credit Card Number: Expiration Date (mm/yyyy):

Your Signature:

If the Credit Card is not your own:

Owners name: Credit Card billing address:

Card owners Signature:

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Your Name:		Your Phone number:
Street address:		Your fax Number:
City:		Your e-mail address:
State:		Postal (Zip) Code:
Country:

If paying by Credit Card:
Credit Card Type (Visa, MasterCard, etc.):
Credit Card Number:		Expiration Date (mm/yyyy):
Your Signature:
If the Credit Card is not your own:
Owners name:		Credit Card billing address: