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Applicant Information Mandatory Fields
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| SSN / Tax ID: * |
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| First Name: * |
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| Middle Name: * |
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| Last Name: * |
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| Billing Address Number And Street 1: * |
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| Shipping Address 2 If is Different: |
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| City: * |
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| Zip Code: * |
(5 digits) |
| Country: * |
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| DayTime Phone: * |
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| Evening Time Phone: |
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| Fax Number: |
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| State: * |
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| Co-Applicant Information |
| Co-Applicant SSN / Tax ID: * |
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| Co-Applicant First Name: |
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| Co-Applicant MI: |
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| Co-Applicant Last Name: |
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| Contact Phone: * |
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| How Would You Like To Start (Select One) |
| $199.oo OG - BRONCE |
Bronce Promotional Pack (Incl. Business Kit And 150 CV.) |
| $499.oo OG - SILVER |
Silver Promotional Pack (Incl Business Kit And 400 CV.) |
| $1295.oo OG - GOLD |
Gold promotional pack (Incl. Business Kit And 875 CV.)
* 20% Mathching Bonus As A Qualified Consultant. |
| Auto Ship Initial Order |
| Three Pack ($48.oo)-------50 PV |
Three Pack($48.oo) 50 PV |
| Six Pack ($96.oo) ---------100 PV |
Six Pack ($96.oo)c100 PV |
| 12 Pkg ($192.oo) ----------200 PV |
Twelve Pack ($192.oo) 200 PV |
| AutoShip the |
1st 15th |
| Of the Following Month, |
Three Pack Includes OG Assorted Beverages (3 Boxes) |
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Product Return Policy
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Merchandises that are, unopened and resalable may be returned for refund within 30 calendar days of the invoive date with no affect on Representative Status, except insofar as said returned volume may affect PV and/ or GV for paid rank qualifications. The representative will be responsible for the return shipping cost. The invoided amount will be refunded, minus shipping and handling to the Represantative in the same form as the original payment was submited. A refund will only be processed once the warehouse department has received and inspected the return products.
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| Credit Card Payment Information |
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Visa |
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Master Card |
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Amex |
| Credit Card Number: * |
(Minimum 16 Digits) |
| Expires Month: * |
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| Expires Year: * |
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| CCV: * |
(Digits / Numbers Back On Credit / Debit Card) |
| Credit Card Holder Name: * |
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| undefined: |
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Note: All orders Will Be Charged Applicable Taxes, Shipping And Handling. |
| User/Site Name |
.organogold.com.na.biz |
| Password: |
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| Secret Answer: |
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| User / Site Name |
is Interchangeable With Your Member ID# * The Field Above Used In Case You Forgot Your Password |
| DAVID |
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Representative Agreement (Please Read And Sign)
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I /We acknowledge That I / We Have Carefully Read All The Terms And Conditions. I / We Understand The Terms And Conditions Contained Herewith Along With The Statement Of Policies & Procedures, Wich By Reference Are Fully Incorporated In This Document, And Agree To Be bound By Them.
I / We Also Understand That I / We may Terminate My / Our Independent OrGano Gold Representative Status At Any Time With Written Notice To OrGano Gold.
I / We Understand That It Is My Responsability To Ensure That Product Sales, As Well As Payment For Such Sales, Are Proccesed Prior To The End Of A Commission Period To Be Eligible For A Commission. |
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Signatures
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| Applicant's Signature: * |
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| Date: |
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| Co-Applicant"s Signature: * |
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| Date: |
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