Body Balance Autoship Form

New Zealand PO3

CONTACT DETAILS

[ * required field ]

First Name *

Last Name *

Email *

Mobile Phone *

Name of the person who referred you to Body Balance *

Youngevity ID number of the person who referred you to Body Balance. Write unknown if you don't know *

DELIVERY DETAILS

[ * required field ]

Address *

City *

Postcode *

Country *

Please leave my parcel at the door if no one's home. (I accept the risk of damage or stolen.)

CHOOSE PRODUCT

BODY BALANCE PACKS

Body Balance Liquid pack (960ml*4 bottles) = $184.00

Body Balance Liquid pack (960ml*8 bottles) = $336.20

Body Balance Powder pack (5g*32 sachet) = $184.00

Body Balance Powder pack (5g*64 sachet) = $336.20

Additional note

TERMS & CONDITIONS

By submitting this form, I will be enrolling to Youngevity monthly Autoship as per PO3 Plan; I authorise the payment for products, shipping and handling ordered from this form with the credit card below.

PAYMENT DETAILS

Credit Card Holder Name *

Card Number *

Expiration Month *

Expiration Year *

Country Issued *

* this order will be processed on next business day. All prices are shown and charged in New Zealand dollars.

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