UHS Essential Health Philippines, Inc.

Makati Office

Philippines Associate 24th Floor, Tower 1, The Enterprise Center,

6766 Ayala Avenue corner Paseo de Roxas,
Makat City, Philippines 1223
Application & Agreement Davao Office
7th Florr, Abreeza Corporate Center
JP Laurel Avenue, Davao City, Philippines 8000
Cebu Office
5th Floor, Tech Tower, Cebu Business Park,
Cebu City, Cebu 6000
Customer Service: customerservicePH@usanainc.com
Phone Order Line: (632) 858-4500
www.USANA.com
ABOUT YOU
*
* Name (Last, first, middle) Applicant Taxpayer Identification Number (TIN)*

* Date of Birth m m d d y y y y Gender: Male Female

Co-applicant Taxpayer Identification Number (TIN)*

* Recognition Name (Name you want to appear in all recognition materials)

Co-Applicant Name (Last, First, Middle) Business or Company Registration Number

Date of Birth m m d d y y y y Gender: Male Female *

Daytime Phone Number
* Street Address
City/Municipality Province Zip Code
Evening Phone Number
* Email (Main Applicant) Email

Mobile Phone Number

YOUR SPONSOR INFORMATION YOUR PLACEMENT INFORMATION

SPONSOR NAME (Last, first, middle) Name of the person whom the applicant will be placed under (Last, first, middle)
Left Right

Linkage
Associate Number Sponsor Telephone Number Associate Number Business Center (mark one)

GETTING STARTED
Total
WELCOME KIT $9.95 US PLUS SALES TAX.
All new Associates must purchase a Welcome Kit. P
Open 1 Business Center Open 3 Business Centers
(minimum of 200 SVP) (minimum of 400 SVP)
P
Item # Qty. Product name SV Product Price

For this order, do you want to: P

Pick it up from Makati/Davao/Cebu Office

Have it delivered to you

(Shipping information on back)
P

SAVE 10% WITH AUTO ORDER – YOUR SUBSCRIPTION TO HEALTH

Please enroll me in the USANA Auto Order Program. I understand I will recevie my designated order every 4 weeks after my initial order. Initial Here
P
Item # Qty. Product name SV Product Price
For subsequent orders starting four
(4) weeks from now, do you want to:
P
Pick it up from Makati/Davao/Cebu Office

Have it delivered to you

(Shipping information on back) P

HOW WILL YOU PAY?

Select a method of payment for ordering. The account information will be kept on file for future orders.
I hereby authorize UHS Essential Health Philippines, Inc. (USANA) to
Regular Payment: Visa Bank Payment System (BPS)
receive payment via my credit card for the cost of my Welcome Kit and
MasterCard initial product order as well as any and all of my future product orders.
USANA is authorized to withdraw payment equal only to the amount of
the products that I order, plus applicable sales taxes and shipping and
mm yy
handling; or for the amount of the Auto order I have established (plus
Card Number Expires additional amounts for substituted products if my regular products
are unavailable), and sales taxes, shipping and handling. I authorize
USANA to charge the account listed in this agreement a total of P940
Cardholder Name (plus applicable sales taxes) on an annual basis for the purpose of
automatically renewing my Associate Agreement. This amount shall be
charged on the anniversary date of my application.
WHERE WILL YOUR COMMISSION GO?

Your Name (as it appears on your bank account) Savings Checking

Bank Name Bank Account Number

Page 1 of 2
CCR-017040 PH EN 0721
 AGREEMENT

I CERTIFY THAT I AM OF THE AGE OF MAJORITY IN MY COUNTRY OR RESIDENCE.

I HAVE REVIEWED AND AGREE TO USANA’S TERMS & POLICIES AND COMPENSATION PLAN.
(To obtain a copy of the Terms & Policies and Compensation Plan, please call Customer Service at (632) 858-4500.)

I HAVE REVIEWED USANA’S COMPENSATION PLAN. I UNDERSTAND THAT USANA DOES NOT GUARANTEE ASSOCIATES’ FINANCIAL
SUCCESS AND I CERTIFY THAT NO ONE HAS ASSURED ME THAT MY USANA INDEPENDENT BUSINESS WILL BE PROFITABLE.

I UNDERSTAND THAT I AM AN INDEPENDENT CONTRACTOR AND WILL NOT BE TREATED AS AN EMPLOYEE OF USANA FOR TAX
PURPOSES OR FOR ANY OTHER REASON.

SIGNATURE

Applicant Signature Date Co-Applicant Signature Date

Page 2 of 2
CCR-017040 PH EN 0721