Preferred Customer Application - Support Centreneriumsupport.com/downloads/pc_application_form_nov-29.pdfPreferred Customer Application Payment Method Visa MasterCard Discover _____
Post on 08-Mar-2018
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Preferred Customer Appl icat ion
Payment Method
Visa MasterCard Discover
_________________________________________
Card Number
_________ /____________ __________________
EXP. (MO/Year) Security Code
_________________________________________
Name on Card
_________________________________________
Billing Address
_____________________ ______ ___________
City ST/Prov. Zip/Postal Code
_________________________________________
Signature of Cardholder
Referral Website Information Choose a name for your branded Nerium referral websiteExample: www.yourname.neriumproducts.com
__________________________________ __________________________________ Option 1 Option 2
This will also be your username for logging in to your personal account. Retail customers will use your email address to place orders.
Choose a Password
______________________________________________________________________________________
Password must consist of letters or numbers only. Must be 4-15 characters in length.
Take advantage of our 3UR Free program. Simply sign up three active Preferred Customers in the Auto-Delivery Order program, and you’ll get your next month’s Auto-Delivery Order of NeriumAD Age-Defying Treatment for free!
I authorize Nerium International™ to charge the above named account for the purchase option selected. I understand that Nerium International will apply applicable taxes and shipping and handling charges to my order. An Auto-Delivery Order is included in this purchase option. I authorize Nerium International to ship/charge for these products monthly. Cancellation must be submitted in writing at least five (5) business days prior to the Auto-Delivery billing cycle date. I understand that all financial transactions are in US Dollars.
Preferred Customer Signature: ______________________________________________________ Date: ____________________________________All signatures to this application must be affixed personally. Applicants must be of legal age.
I would like to become a Nerium International Preferred Customer and receive my product every month at a discounted price.
Shipping and handling and applicable sales tax will be added to my total order at the time it is processed.
Please enroll me in the Auto-Delivery Order Program. My Auto-Delivery Order will be processed and shipped starting next month, on the same day of the month that this original order is processed. If that day falls on a weekend or holiday, the order will be processed on the last business day prior. The payment method used for my initial enrollment will be used for my Auto-Delivery Order. The product order I receive will be shipped monthly.
Signature: ____________________________________________________________________
Save $30-45 USD per order as a Preferred Customer!
Fax to: 214.390.9988
© 2 0 1 3 N e r i u m I n t e r n a t i o n a l ™, L L C . A l l R i g h t s R e s e r v e d . R e v i s e d 9 / 1 3 .
Who Introduced You to Nerium?______________________________________________________________________________________Nerium ID Number or Username_______________________________________________ _____________________________ _______ Name (First, Last) City ST/Prov
Personal Information_____________________________________________________________________ _______________Name (Last, First, Middle) Date of Birth (optional)
______________________________________________________________________________________Business Name (if applicable)
______________________________________________________________________________________Shipping Address (Must be a physical address. Cannot ship to a P. O. Box)_______________________________________________ _______ ________________ __________ City ST/Prov Zip/Postal Code Country__________________________________________ __________________________________________Email Phone Number (check one: cell home)
Purchase Product
Quantity Description Auto-Delivery Preferred Customer Price: Total
NeriumAD Age-Defying Treatment $80/Bottle of night cream
NeriumAD Combo Pack $120/Pack of day and night cream
NeriumAD® Age-Defying Treatment
NeriumAD products are developed from the patented extract of the Nerium oleander plant. They contain the most effective age-defying ingredients, chosen for both their individual and synergistic benefits. These premium ingredients are blended at optimum levels to nourish your skin and provide real results.
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