Amway India Enterprises

Regd. Office : C-3, Qutab Institutional DISTRIBUTOR ORDER FORM TM

Area, New Delhi - 110 016 (UPDATED ON 01/05/2006)
DISTRIBUTOR NUMBER :
PUC HD
Location : Date :
DISTRIBUTOR NAME :

Total Total
SKU Nos. Qty. DESCRIPTION PV DAP* SKU Nos. Qty. DESCRIPTION PV DAP*
Value Value
874 Voucher Pack ........ 4400.00 COSMETICS
873 Complete Business Kit ........ 4400.00 100227 Replenishing Daily Eye Cream 9.82 499.00
NUTRITION & WELLNESS 100789 Pure Whitening Essence 30.31 1541.00
100141 Nutrilite Protein Powder 500gms 26.37 1341.00 3434 Time Defiance Lotion 34.40 1749.00
100142 Nutrilite Protein Powder 200gms 12.75 649.00 100240 Skin Refinishing Lotion 32.75 1666.00
5985 Siberian Ginseng 100 Tabs 38.82 1974.00 3442 Time Defiance Cream 34.40 1749.00
100309 Triple Guard Echinicea 60 Tabs 21.11 1074.00 3433 T D Day Time Protection Cream 34.40 1749.00
8086 Glucosamine HCL 120 Tabs 38.82 1974.00 5011 Moisture Rich Vitalising Cleanser 16.37 833.00
100260 Nutrilite Daily 60 Tabs 17.02 866.00 5012 Moisture Rich Refreshing Toner 16.37 833.00
102745 Nutrilite Daily 120 LM 28.67 1458.00 5013 Moisture Rich Protective Moisturiser 20.31 1033.00
100863 Nutrilite Kids Chewable 60 Tabs 16.86 858.00 5014 Clarifying Foaming Cleanser 16.37 833.00
100997 Nutrilite Iron Folic 90 Tabs 11.13 566.00 5015 Clarifying Oil Control Toner 16.37 833.00
100089 Nutrilite Kids Berry Blast 500 gms 13.42 683.00 5016 Clarifying Balancing Moisturiser 20.31 1033.00
101153 Nutrilite BIO C 100 Tabs 16.38 833.00 8006 Alpha Hydroxy Serum Plus 32.75 1666.00
101154 Nutrilite Parselenium E 30 Tabs 16.38 833.00 100196 Polishing Scrub 16.37 833.00
100021 Nutrilite Cal Mag LM 90 Tabs 8.51 433.00 100198 Moisture Intense Masque 16.37 833.00
101419 Nutrilite Natural B 100 Tabs 10.98 558.00 67 Foundation - Shell Bisque 21.29 1083.00
89 Nut. Bone Health with IVP-60 Tabs 36.04 1833.00 72 Foundation - Honey Creme 21.29 1083.00
100066 Salmon Omega 3 - 60 Tabs 18.82 958.00 2265 Foundation - Satin Beige 21.29 1083.00
9575 Positrim Starter Kit 0.00 500.00 4871 Loose Powder - Fair 21.29 1083.00
212132 Positrim Low Fat Drink Mix 26.20 1332.00 4872 Loose Powder - Medium 21.29 1083.00
HOME CARE 4873 Loose Powder - Dark 21.29 1083.00
8156 L.O.C. High Suds 1 Ltr 5.89 299.00 3887 Body Definer Firming Gel 16.37 833.00
8392 L.O.C. High Suds 500ml 3.51 179.00 211461 Attitude Face Wash 3.27 166.00
137 L.O.C. Sachet 0.09 5.00 211463 Attitude Sun Screen 4.89 249.00
228 Dish Drop 1 Ltr 7.53 383.00 211467 Normal to Oily Cleanser 4.89 249.00
8391 Dish Drop 500ml 4.51 229.00 211468 Normal to Oily Toner 4.89 249.00
138 Dish Drop Sachet 0.09 5.00 211469 Normal to Oily Moisturiser 7.36 374.00
8393 Zoom 500ml 3.42 174.00 211470 Normal to Dry Cleanser 4.89 249.00
3941 See Spray 500ml 3.42 174.00 211471 Normal to Dry Toner 4.89 249.00
33 S A 8 Gelzyme 1 ltr 9.82 499.00 211472 Normal to Dry Moisturiser 7.36 374.00
101158 S A 8 Gelzyme 500ml 5.73 291.00 211450 Attitude Foot Creame 4.08 208.00
58 Pursue Disinfectant Cleaner 5ltr 21.96 1116.00 211473 Attitude Hand & Body Creame 4.08 208.00
103 Pursue-200ml 1.73 88.00 SALES AID
7506 Pursue Disinfectant Cleaner 500ml 3.60 183.00 868 Personal Care Pump Disp. 0.00 21.00
4110 S A 8 Delicate 500ml 5.66 288.00 1605 Home Care Pump Disp. 1 ltr 0.00 46.00
4111 Car Wash 500ml 3.60 183.00 9061 Home Care Pump Disp. 500 ml 0.00 46.00
59 Car Wash Sachet 0.09 5.00 204239 Pour & Measure Cap 0.00 45.00
8095 Leather & Vinyl Cleaner 4.24 216.00 1065 Pistol Grip Sprayer 0.00 27.00
8371 Buff-up 5.89 299.00 1075 Squeeze Bottle 0.00 18.00
8945 Pre Wash Liquid 5.40 275.00 1026 Turret Top Cap 0.00 9.00
100949 APSA - 80 500 ml 5.73 291.00 9599 Wall Calendar 0.00 65.00
3417 APSA - 80 1 Ltr. 9.60 488.00 9600 Desk Calendar 0.00 49.00
8967 Silicone Glaze 6.64 338.00 9137 Body Sponge (Ivory) 0.00 36.00
PERSONAL CARE 9198 Body Sponge (Peach) 0.00 36.00
1202 Satinique 2-in-1 250 ml 5.73 291.00 GREETING CARDS
100659 Satinique 2-in-1 60 ml 1.73 88.00 9487 AOF-Cry Seasons Greeting Cards-10 1.67 83.00
29 Satinique 2-in-1 Sachet 0.09 5.00 9169 Thank You Greeting Cards-10 1.62 82.00
140 D.C. Shampoo Sachet 0.09 5.00 9170 Congratulations Greeting Cards-10 1.62 82.00
141 D.C. Conditioner Sachet 0.09 5.00 9569 AOF-Seasons Greeting Cards-10 1.67 84.00
2183 G & H Lotion 250 ml 5.73 291.00 B S M - TELUGU
100661 G & H Lotion 60 ml 1.73 88.00 9232 APSA Brochure 0.00 35.00
100 G & H Lotion Sachet 0.09 5.00 9408 Opportunity Brochure 0.00 20.00
6826 G & H Body Shampoo 5.73 291.00 9467 APSA 80 Adv Brochure 0.00 22.00
100660 G & H Body Shampoo 60 ml 1.73 88.00 B S M - ENGLISH
200760 Glister Multi - Action TP 1.89 96.00 9605 HLE Kit 0.00 749.00
211458 Persona New Advanced Toothbrush 1.96 100.00 9321 Opportunity Brochure English - 10 0.00 20.00
9707 Persona Talcum Powder 2.93 149.00 9376 S A 8 Gel Adv. Brochure - 5 0.00 23.00
100078 Persona Jr. Tooth Brush Packet of 4 1.64 84.00 9389 Home Care Brochure - 1 0.00 15.00
2184 Nature Shower Creme Hand Soap 5.73 291.00 9391 Home Care CD (English) 0.00 50.00
100256 Persona Bar Soap - Pack of 3 1.80 90.00 9458 Healthy Life with Iron Folic Audio Cast 0.00 25.00
100950 Sweet Shot Mint 2.44 124.00 9462 Artistry Speciality Brochure - 5 0.00 35.00
100951 Sweet Shot Cinnamon 2.44 124.00 9463 Artistry Daily Care Brochure - 5 0.00 40.00
5070 Sat. Hair Rejuvenating Masque 6.53 333.00 9477 Berry Blast Oppor. CD 0.00 50.00
212738 Dynamite Shaving Foam 4.09 208.00 9482 Nutrilite Natural B Brochure - 10 0.00 35.00
212739 Dynamite After Shave Moisture 2.44 124.00 9485 Power of Soy Protein (E&H) Cast 0.00 25.00
212740 Dynamite After Shave Splash 4.91 249.00

1. In case of TNA, would you like Amway to place alternate order for you of the same PV's Yes No
2. The above prices are subject to change. Please check the actual price before placing the order. Please put the Ship to Address on the reverse side of the Order Form)

PAYMENT DETAILS
By DD/Cheque__________________________(DD/Cheque No._________________Dt.:____________________By Cash_____________________ ______________________
Bank___________________________Payable at__________________________________By COD Distributor's Signature
Credit Card No.___________________________________________________________________ Please fill in this form all relevant information before you approach the cashier
Card Holder's Name_______________________________________________________________ Please present your Amway ID card or Copy of SA 88 ID (Application Form
Trademarks of Amway Corp. Ada. MI U.S.A. All rights reserved. Printed in India.)
Expiry Date______________________________ (Only Master/ Visa Card)
P.T.O.

TEAR OFF
Receipt (To be filled in by Cashier)
ORDER NO. DATE AMOUNT CASH / CC / DD / BC / AR / PC

Cashier's Signature
 Total Total
SKU Nos. Qty. DESCRIPTION PV DAP* SKU Nos. Qty. DESCRIPTION PV DAP*
Value Value
9486 Nutrilite Natural B Edge CD 0.00 50.00 BSM - HINDI
9488 Nutrilite Corporate Brochure - 5 0.00 47.00 9392 Home Care CD 0.00 50.00
9489 Nutrilite Product Info Booklet - 5 0.00 55.00 9390 Home Care Brochure - 1 0.00 15.00
9523 Dynamite Prod. Bro. - 5 0.00 20.00 9398 SA 8 Gel Advance Brochure - 5 0.00 23.00
9524 Dynamite CD 0.00 50.00 9479 Nutrilite Cal - Mag Brochure - 10 0.00 25.00
9528 L. Kims Speech 2005 (E&H) 0.00 25.00 9406 Opportunity Brochure (Hindi) - 10 0.00 20.00
9550 Bone Health Brochure 0.00 57.00 9475 Artistry Spec. Brochure - 5 0.00 35.00
9551 Bone Health Audio Cassette 0.00 25.00 9437 First step to Success CD 0.00 50.00
9547 New Artistry PDT. Bro. 0.00 40.00 9401 Nut. Parselenium E Brochure - 10 0.00 35.00
9531 Nut. Business Bosster 0.00 225.00 9484 Nutrilite Natural B Brochure - 10 0.00 35.00
9547 Artistry Bro. (E) 0.00 40.00 9520 Attitude Booklet - 5 0.00 30.00
9548 Corporate Bro. 0.00 75.00 9505 APSA-80CD (Hindi/Guj/Bengali/Mar)-5 0.00 50.00
9533 ALS Brochure & CD 0.00 75.00 9580 Artistry Beauty Book - 3 0.00 40.00
9561 Corporate & Youth Video CD 0.00 99.00 9594 Amsure Film C.D. 0.00 50.00
9577 Nut. Salmon Omega Bro. 0.00 35.00 9564 Bone Health Bro. - 10 0.00 57.00
9579 Nut. Salmon Omega CD 0.00 50.00 9581 Nut. Salmon Omega Bro. - 10 0.00 35.00
9595 Attitude Bro. - 5 0.00 35.00 9351 Nut. Vitabuddy 0.00 60.00
9606 Attitude Film C.D. 0.00 50.00 9628 Positrim Brochure (H) - 10 0.00 35.00
9588 Amsure Opportunity Bro. 0.00 22.00
9589 Amsure Business Builder 0.00 10.00 B S M TAMIL
9590 Amsure Family Money Back 0.00 10.00 9233 APSA Brochure 0.00 35.00
9591 Amsure Bonus Builder Bro. 0.00 10.00 9407 Opportunity Brochure 0.00 20.00
9592 Amsure Future Builder Bro. - 5 0.00 10.00 9465 APSA 80 Adv Brochure 0.00 22.00
9593 Amsure Film C.D. (E) - 10 0.00 50.00
9625 Positrim Brochure (E) - 10 0.00 35.00 B S M MALAYALAM
9608 Positrim CD 0.00 50.00 9409 Opportunity Brochure 0.00 20.00
9629 Healthy Shakes with Positrim - 5 0.00 40.00
B S M KANNADA
9410 Opportunity Brochure 0.00 20.00

TOTAL AMOUNT
Distributor No.........................................................
YOUR PARTICULARS : SHIP - TO ADDRESS PLEASE TICK IF DIFFERENT FROM ADDRESS ON FILE (Not available when paying by credit card)

(Only for Home Delivery Orders)

* Distributor First Name (Distributor Names, if applicable, as specified on file) (Surname or name of Indian proprietorship concern or Indian partnership)

* Ship-To-Address

* Ship-To-Address

Locality

* City / Town * District

State PIN Code Name of Post Office

OR
* Land Mark (Please specify a landmark near your address for ease of delivery)

* Telephone (Residence) * Telephone (Office)

STD CODE PHONE NO. STD CODE PHONE NO.

Mobile E-mail

* Fields are mandatory.

IF YOU ARE PAYING BY CASH AND OF RS. 500/- DENOMINATION PLEASE FILL THE BELOW PART NOS. OF NOTES (RS. 500/- ONLY):-

1 6 11 16 21 26

2 7 12 17 22 27

3 8 13 18 23 28

4 9 14 19 24 29

5 10 15 20 25 30