Order Form | Cheque | Business

Amway India Enterprises

Regd. Office : C-3, Qutab Institutional
Area, New Delhi - 110 016

DISTRIBUTOR ORDER FORM

DISTRIBUTOR NUMBER :
DISTRIBUTOR NAME

PUC

DAP*

Voucher Pack
Complete Business Kit

........
........

4400.00
4400.00

100141
100142
5985
100309
8086
100260
102745
100863
100997
100089
101153
101154
100021
101419
89
100066
9575
212132

Nutrilite Protein Powder 500gms
Nutrilite Protein Powder 200gms
Siberian Ginseng 100 Tabs
Triple Guard Echinicea 60 Tabs
Glucosamine HCL 120 Tabs
Nutrilite Daily 60 Tabs
Nutrilite Daily 120 LM
Nutrilite Kids Chewable 60 Tabs
Nutrilite Iron Folic 90 Tabs
Nutrilite Kids Berry Blast 500 gms
Nutrilite BIO C 100 Tabs
Nutrilite Parselenium E 30 Tabs
Nutrilite Cal Mag LM 90 Tabs
Nutrilite Natural B 100 Tabs
Nut. Bone Health with IVP-60 Tabs
Salmon Omega 3 - 60 Tabs
Positrim Starter Kit
Positrim Low Fat Drink Mix

26.37
12.75
38.82
21.11
38.82
17.02
28.67
16.86
11.13
13.42
16.38
16.38
8.51
10.98
36.04
18.82
0.00
26.20

1341.00
649.00
1974.00
1074.00
1974.00
866.00
1458.00
858.00
566.00
683.00
833.00
833.00
433.00
558.00
1833.00
958.00
500.00
1332.00

8156
8392
137
228
8391
138
8393
3941
33
101158
58
103
7506
4110
4111
59
8095
8371
8945
100949
3417
8967

L.O.C. High Suds 1 Ltr
L.O.C. High Suds 500ml
L.O.C. Sachet
Dish Drop 1 Ltr
Dish Drop 500ml
Dish Drop Sachet
Zoom 500ml
See Spray 500ml
S A 8 Gelzyme 1 ltr
S A 8 Gelzyme 500ml
Pursue Disinfectant Cleaner 5ltr
Pursue-200ml
Pursue Disinfectant Cleaner 500ml
S A 8 Delicate 500ml
Car Wash 500ml
Car Wash Sachet
Leather & Vinyl Cleaner
Buff-up
Pre Wash Liquid
APSA - 80 500 ml
APSA - 80 1 Ltr.
Silicone Glaze

5.89
3.51
0.09
7.53
4.51
0.09
3.42
3.42
9.82
5.73
21.96
1.73
3.60
5.66
3.60
0.09
4.24
5.89
5.40
5.73
9.60
6.64

299.00
179.00
5.00
383.00
229.00
5.00
174.00
174.00
499.00
291.00
1116.00
88.00
183.00
288.00
183.00
5.00
216.00
299.00
275.00
291.00
488.00
338.00

1202
100659
29
140
141
2183
100661
100
6826
100660
200760
211458
9707
100078
2184
100256
100950
100951
5070
212738
212739
212740

Satinique 2-in-1 250 ml
Satinique 2-in-1 60 ml
Satinique 2-in-1 Sachet
D.C. Shampoo Sachet
D.C. Conditioner Sachet
G & H Lotion 250 ml
G & H Lotion 60 ml
G & H Lotion Sachet
G & H Body Shampoo
G & H Body Shampoo 60 ml
Glister Multi - Action TP
Persona New Advanced Toothbrush
Persona Talcum Powder
Persona Jr. Tooth Brush Packet of 4
Nature Shower Creme Hand Soap
Persona Bar Soap - Pack of 3
Sweet Shot Mint
Sweet Shot Cinnamon
Sat. Hair Rejuvenating Masque
Dynamite Shaving Foam
Dynamite After Shave Moisture
Dynamite After Shave Splash

5.73
1.73
0.09
0.09
0.09
5.73
1.73
0.09
5.73
1.73
1.89
1.96
2.93
1.64
5.73
1.80
2.44
2.44
6.53
4.09
2.44
4.91

291.00
88.00
5.00
5.00
5.00
291.00
88.00
5.00
291.00
88.00
96.00
100.00
149.00
84.00
291.00
90.00
124.00
124.00
333.00
208.00
124.00
249.00

874
873

1.
2.

HD

:
PV

SKU Nos. Qty.

DESCRIPTION

NUTRITION & WELLNESS

HOME CARE

PERSONAL CARE

TM

(UPDATED ON 01/05/2006)

Total
Value

SKU Nos. Qty.

Location :

Date :

DESCRIPTION

PV

DAP*

9.82
30.31
34.40
32.75
34.40
34.40
16.37
16.37
20.31
16.37
16.37
20.31
32.75
16.37
16.37
21.29
21.29
21.29
21.29
21.29
21.29
16.37
3.27
4.89
4.89
4.89
7.36
4.89
4.89
7.36
4.08
4.08

499.00
1541.00
1749.00
1666.00
1749.00
1749.00
833.00
833.00
1033.00
833.00
833.00
1033.00
1666.00
833.00
833.00
1083.00
1083.00
1083.00
1083.00
1083.00
1083.00
833.00
166.00
249.00
249.00
249.00
374.00
249.00
249.00
374.00
208.00
208.00

COSMETICS

100227
100789
3434
100240
3442
3433
5011
5012
5013
5014
5015
5016
8006
100196
100198
67
72
2265
4871
4872
4873
3887
211461
211463
211467
211468
211469
211470
211471
211472
211450
211473

Replenishing Daily Eye Cream
Pure Whitening Essence
Time Defiance Lotion
Skin Refinishing Lotion
Time Defiance Cream
T D Day Time Protection Cream
Moisture Rich Vitalising Cleanser
Moisture Rich Refreshing Toner
Moisture Rich Protective Moisturiser
Clarifying Foaming Cleanser
Clarifying Oil Control Toner
Clarifying Balancing Moisturiser
Alpha Hydroxy Serum Plus
Polishing Scrub
Moisture Intense Masque
Foundation - Shell Bisque
Foundation - Honey Creme
Foundation - Satin Beige
Loose Powder - Fair
Loose Powder - Medium
Loose Powder - Dark
Body Definer Firming Gel
Attitude Face Wash
Attitude Sun Screen
Normal to Oily Cleanser
Normal to Oily Toner
Normal to Oily Moisturiser
Normal to Dry Cleanser
Normal to Dry Toner
Normal to Dry Moisturiser
Attitude Foot Creame
Attitude Hand & Body Creame

868
1605
9061
204239
1065
1075
1026
9599
9600
9137
9198

Personal Care Pump Disp.
Home Care Pump Disp. 1 ltr
Home Care Pump Disp. 500 ml
Pour & Measure Cap
Pistol Grip Sprayer
Squeeze Bottle
Turret Top Cap
Wall Calendar
Desk Calendar
Body Sponge (Ivory)
Body Sponge (Peach)

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

21.00
46.00
46.00
45.00
27.00
18.00
9.00
65.00
49.00
36.00
36.00

9487
9169
9170
9569

AOF-Cry Seasons Greeting Cards-10
Thank You Greeting Cards-10
Congratulations Greeting Cards-10
AOF-Seasons Greeting Cards-10

1.67
1.62
1.62
1.67

83.00
82.00
82.00
84.00

9232
9408
9467

APSA Brochure
Opportunity Brochure
APSA 80 Adv Brochure

0.00
0.00
0.00

35.00
20.00
22.00

9605
9321
9376
9389
9391
9458
9462
9463
9477
9482
9485

HLE Kit
Opportunity Brochure English - 10
S A 8 Gel Adv. Brochure - 5
Home Care Brochure - 1
Home Care CD (English)
Healthy Life with Iron Folic Audio Cast
Artistry Speciality Brochure - 5
Artistry Daily Care Brochure - 5
Berry Blast Oppor. CD
Nutrilite Natural B Brochure - 10
Power of Soy Protein (E&H) Cast

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

749.00
20.00
23.00
15.00
50.00
25.00
35.00
40.00
50.00
35.00
25.00

In case of TNA, would you like Amway to place alternate order for you of the same PV's Yes
The above prices are subject to change. Please check the actual price before placing the order.

SALES AID

GREETING CARDS

B S M - TELUGU

B S M - ENGLISH

No

Total
Value

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
Credit Card No.___________________________________________________________________
Card Holder's Name_______________________________________________________________
Expiry Date______________________________ (Only Master/ Visa Card)

______________________
Distributor's Signature

Please fill in this form all relevant information before you approach the cashier
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.)
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

SKU Nos. Qty.
9486
9488
9489
9523
9524
9528
9550
9551
9547
9531
9547
9548
9533
9561
9577
9579
9595
9606
9588
9589
9590
9591
9592
9593
9625
9608
9629

DESCRIPTION
Nutrilite Natural B Edge CD
Nutrilite Corporate Brochure - 5
Nutrilite Product Info Booklet - 5
Dynamite Prod. Bro. - 5
Dynamite CD
L. Kims Speech 2005 (E&H)
Bone Health Brochure
Bone Health Audio Cassette
New Artistry PDT. Bro.
Nut. Business Bosster
Artistry Bro. (E)
Corporate Bro.
ALS Brochure & CD
Corporate & Youth Video CD
Nut. Salmon Omega Bro.
Nut. Salmon Omega CD
Attitude Bro. - 5
Attitude Film C.D.
Amsure Opportunity Bro.
Amsure Business Builder
Amsure Family Money Back
Amsure Bonus Builder Bro.
Amsure Future Builder Bro. - 5
Amsure Film C.D. (E) - 10
Positrim Brochure (E) - 10
Positrim CD
Healthy Shakes with Positrim - 5

PV

DAP*

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

50.00
47.00
55.00
20.00
50.00
25.00
57.00
25.00
40.00
225.00
40.00
75.00
75.00
99.00
35.00
50.00
35.00
50.00
22.00
10.00
10.00
10.00
10.00
50.00
35.00
50.00
40.00

Total
Value

SKU Nos. Qty.

DESCRIPTION

BSM - HINDI

9392
9390
9398
9479
9406
9475
9437
9401
9484
9520
9505
9580
9594
9564
9581
9351
9628

Home Care CD
Home Care Brochure - 1
SA 8 Gel Advance Brochure - 5
Nutrilite Cal - Mag Brochure - 10
Opportunity Brochure (Hindi) - 10
Artistry Spec. Brochure - 5
First step to Success CD
Nut. Parselenium E Brochure - 10
Nutrilite Natural B Brochure - 10
Attitude Booklet - 5
APSA-80CD (Hindi/Guj/Bengali/Mar)-5
Artistry Beauty Book - 3
Amsure Film C.D.
Bone Health Bro. - 10
Nut. Salmon Omega Bro. - 10
Nut. Vitabuddy
Positrim Brochure (H) - 10

9233
9407
9465

APSA Brochure
Opportunity Brochure
APSA 80 Adv Brochure

9409

Opportunity Brochure

9410

Opportunity Brochure

B S M TAMIL

B S M MALAYALAM
B S M KANNADA

PV

DAP*

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

50.00
15.00
23.00
25.00
20.00
35.00
50.00
35.00
35.00
30.00
50.00
40.00
50.00
57.00
35.00
60.00
35.00

0.00
0.00
0.00

35.00
20.00
22.00

0.00

20.00

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.

Mobile

STD CODE

PHONE NO.

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

Total
Value

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