Amway India Enterprises Pvt. Ltd.

Regd Office : First Floor, Elegance Tower, Plot No. 8,

Non Hierarchical Commercial Centre, Jasola, New Delhi - 110 025. DISTRIBUTOR ORDER FORM Updated On 22-11-10
TM
DISTRIBUTOR NUMBER :
PICK UP HOME DELIVERY
DISTRIBUTOR NAME : Location : DATE :

SKU Nos. Qty Description PV DAP* Total SKU Nos. Qty Description PV DAP* Total
Value Value
9788 Numberless Application Pad - 20 ---- 100.00 5070 Sat. Hair Rejuvenating Masque 5.62 349.00
236691 New Literature Kit - English ---- 995.00 5030 Satinique Adv. 2 in 1 Sh. & Cond. 4.93 308.00
236754 New Literature Kit - Hindi ---- 995.00 5050 Satinique Adv. Moist. Detang & Cond. 4.93 308.00
5060 Satinique Adv. Dandruf Contl Shmp. 4.93 308.00
NUTRITION & WELLNESS 230396 Attitude Deodrant for Women 150ml 2.78 174.00
107766 Nutrilite Protein Powder 1 Kg. 39.11 2441.00 230414 Dynamite Deodrant for Men 150ml 2.78 174.00
100141 Nutrilite Protein Powder 500 gms 23.09 1441.00 9965 Olive Pomace Oil 1 Litre 2.93 364.00
100142 Nutrilite Protein Powder 200 gms 10.95 683.00
5985 Siberian Ginseng 100 Tabs 35.36 2208.00 COSMETICS
100309 Triple Guard Echinacea 60 Tabs 18.67 1166.00 4871 Loose Powder - Fair 20.11 1249.00
8086 Glucosamine HCL 120 Tabs 35.36 2208.00 4872 Loose Powder - Medium 20.11 1249.00
100260 Nutrilite Daily 60 Tabs 15.35 958.00 107992 Alpha Hydroxy Serum Plus 29.49 1833.00
102745 Nutrilite Daliy 120 Tabs LM 26.02 1624.00 100183 Aritistry Creamy Massage 20.09 1249.00
100863 Nutrilite Kids Chewable 60 Tab 14.67 916.00 100240 Skin Refinishing Lotion 29.49 1833.00
100997 Nutrilite Iron Folic 90 Tabs 9.75 608.00 101821 Time Defiance Day Cream 29.49 1833.00
101153 Nutrilite BIO C 100 Tabs 14.67 916.00 101822 Time Defiance Day Lotion 29.49 1833.00
101154 Nutrilite Parselenium E 30 Tabs 14.67 916.00 101823 Time Defiance Night Time Cream 29.49 1833.00
109960 Nutrilite Cal Mag D 90 Tabs 8.00 499.00 101824 Time Defiance Night Time Lotion 29.49 1833.00
101419 Nutrilite Natural B 100 Tabs 10.00 624.00 103077 SDS Foundation - Cameo 18.76 1166.00
89 Nut. Bone Health with IPR-60 Tabs 30.96 1933.00 103085 SDS Foundation - Almond 18.76 1166.00
100066 Salmon Omega 3 - 60 Tabs 16.00 999.00 104020 Pure Whitening Essence - New 26.80 1666.00
212132 Positrim Chocolate Low Fat Drink Mix-15 23.36 1458.00 104126 Ess Hydrating Cleanser - Dry 14.75 916.00
100076 Nutrilite Garlic Heart Care-60 Tabs 8.27 516.00 104127 Ess Hydrating Toner - Dry 14.75 916.00
100082 Kids Chocolate Drink - 500 gms 12.00 749.00 104128 Ess Hydrating Lotion - Dry 17.42 1083.00
109780 Kids Mango Drink - 500 gms 12.00 749.00 104129 Ess Balancing Cleanser - Oily 14.75 916.00
217040 Positrim Vanilla Low Fat Drink Mix (15) 23.36 1458.00 104130 Ess Balancing Toner - Oily 14.75 916.00
103902 Nut. Kids Banana Drink 12.00 749.00 104131 Ess Balancing Lotion - Oily 17.42 1083.00
100070 Nutrilite CH Balance - 60 Soft Gels 34.85 2166.00 105531 Replenishing Eye Cream 9.38 583.00
105074 Nutrilite Fibre 200 gms 11.07 691.00 106399 Polishing Scrub 14.75 916.00
102992 Nutrilite Conc. Fruit & Veg 60 Tab 20.67 1291.00 106401 Moisture Intense Masque 14.75 916.00
234063ID Lipstick Dark Chocolate 2.80 174.00
HOME CARE 234064ID Lipstick Red Coral 3.20 199.00
8156 L.O.C. High Suds 1 ltr 5.15 321.00 234057ID Lipstick - Shiny Copper 3.20 199.00
8392 L.O.C. High Suds 500 ml 3.09 193.00 234058ID Lipstick - Earthy Brown 2.80 174.00
137 L.O.C. Sachet 8 ml 0.07 5.00 234060ID Lipstick - Natural Pink 2.80 174.00
228 Dish Drop 1 ltr 6.67 417.00 234061ID Lipstick - Pink Diamond 3.20 199.00
8391 Dish Drop 500 ml 3.95 246.00 231748 Attitude Nail Enamel Red Sparkle 1.45 91.00
138 Dish Drop Sachet 8 ml 0.07 5.00 233886 Attitude Eye Pencil - Met Silver 3.35 208.00
8393 Zoom 500 ml 3.09 193.00 233889 Attitude Eye Pencil - Kajal Coal 3.69 229.00
3941 See Spray 500 ml 3.07 192.00 239111 Attitude Eye Pencil - Cobalt Blue 3.69 229.00
33 S A 8 Gelzyme 1 ltr 8.62 538.00 239113 Attitude Eye Pencil - Dark Brown 3.69 229.00
101158 S A 8 Gelzyme 500 ml 5.05 316.00 239112 Attitude Eye Pencil - Deep Purple 3.69 229.00
4110 S A 8 Delicate 500 ml 5.07 317.00 233890 Lip Pencil - Chocolate Brown 3.02 188.00
4111 Carwash 500ml 3.15 196.00 233891 Lip Pencil - Forever Mauve 3.02 188.00
8095 Leather & Vinyl Cleaner 500 ml 3.82 238.00 233892 Lip Pencil - Gorgeous Red 3.02 188.00
8945 S A 8 Pre Wash Liquid 500 ml 4.95 308.00 234073 Mascara 4.69 292.00
100949 APSA - 80 500 ml 5.47 342.00 234246 Attitude Face Wash 3.07 191.00
3417 APSA – 80 1 ltr. 8.95 558.00 234248 Attitude Sun Screen 4.67 291.00
8967 Silicone Glaze 500 ml 6.00 375.00 234249 Attitude Face Masque 3.67 229.00
7506 Pursue Disinfectant 500 ml 3.27 204.00 234250 Attitude Hand & Body Cream 3.47 216.00
234293 Attitude Foot Cream 3.67 229.00
PERSONAL CARE 234294 Eye Liner 5.04 313.00
215434 Sat.Adv.2in1Shamp&Cond.Sach-20 1.40 100.00 234065ID Nail Paints - Cosmic Dust 1.45 91.00
215435 Sat.Adv.Dand’fCntrlShampSach-20 1.40 100.00 234066ID Nail Paints - Fire Storm 1.45 91.00
215436 Sat.Adv. Moist. Detangler Sach-20 1.40 100.00 234067ID Nail Paints - Icy Pink 1.73 108.00
2183 G & H Lotion 250 ml 4.93 308.00 234068ID Nail Paints - Metalic Sand 1.45 91.00
100661 G & H Lotion 60 ml 1.55 96.00 234193ID Attitude Cleanser Oily 4.42 274.00
6826 G & H Body Shampoo 250 ml 4.93 308.00 234209ID Attitude Toner Oily 4.42 274.00
100660 G & H Body Shampoo 60 ml 1.55 96.00 234210ID Attitude Moisturiser Oily 6.91 429.00
241042 Advance SR.Toothbrush(Pack of 4) 1.56 98.00 234214ID Attitude Cleanser Dry 4.42 274.00
215358ID Persona Talcum Powder - 350 gms 2.40 149.00 234215ID Attitude Toner Dry 4.42 274.00
216916ID Persona Talcum Powder - 200 gms 1.60 99.00 234245ID Attitude Moisturiser Dry 6.91 429.00
241041 Advance JR.Toothbrush(Pack of 4) 1.20 75.00 235995ID Att. Tester Pack 1.40 87.00
214087 Persona Bar Soap 3 pcs. 1.47 93.00
2184 Nature Show Crème Hand Soap 250 ml 4.93 308.00
200760 Glister Multi - Action TP 100 g 1.67 104.00
100950 Sweet Shot Mint 2.53 158.00
212738 Dynamite Shaving Foam 3.58 224.00
212739 Dynamite After Shave Moisturiser 2.13 133.00
212740 Dynamite After Shave Splash 4.40 275.00

1. In case of TNA, would you like Amway to place alternate order for you of the same PVs 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 (DD No. Dt.: By Cash
Bank Payable at By COD Distributor’s Signature
Credit No. Please fill in this form all relevant information before you approach the cashier
Card Holder Name Please present you Amway ID card or Copy of SA 88 ID (Application Form)
Trademarks of Amway Corp. Ada. MI U.S.A. All rights revesered. 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
 SKU Nos. Qty Description PV DAP* Total SKU Nos. Qty Description PV DAP* Total
Value Value

GREAT VALUE PRODUCTS

230295 Persona Classic Toothbrush (Pk 4) 1.00 64.00
231244 Dynamite Razors (Pack of 10) 1.75 145.00
241633 Persona 100% Pure Coconut Oil 0.69 86.00
230415 Persona AMLA Hair Oil 200 ml 0.49 60.00
231227 Dynamite Hair Cream 150 g Tube 0.58 73.00
212737 Dynamite Shaving Cream 70 g (2) 0.62 78.00

SALES AID
868 Personal Care Pump Disp. 0.00 21.00
1605 Home Care Pump Disp. 1 ltr 0.00 46.00
9061 Home Care Pump Disp. 500 ml 0.00 46.00
204239 Pour & Measure Cap 0.00 45.00
1065 Pistol Grip Sprayer 0.00 27.00
1075 Squeeze Bottle 0.00 18.00
1404 Turret Top Cap 0.00 9.00
9137 Body Sponge (Ivory) 0.00 36.00
9198 Body Sponge (Peach) 0.00 36.00

BSM
232124ID Eat Hard or Smart Brochure Eng. 0.00 50.00
231991ID Leave Behind Brochure - English 0.00 12.00
234021ID Pocket PDT Brochure Apsa - Eng. 0.00 15.00
235423ID Lifeline Safety Net Brochure 0.00 25.00
233916ID Success Seminar Crown - VCD 0.00 50.00
233306ID N&W Product Handbook - English 0.00 90.00
235227ID Nut. CFV Launch Brochure - Eng. 0.00 50.00
230467ID Jour & Beyond Limit VCD 0.00 100.00
230684IDC All Product HandBook - English 0.00 75.00
WHU9668IDF Home Care Brochure - English 0.00 40.00
236230ID APSA Adv. VIdeo - H-G-B-M 0.00 50.00
236226ID APSA Adv. Brochure Marathi 0.00 30.00
236224ID APSA Adv. Brochure Hindi 0.00 30.00
236932ID Art. Bal & Hyd Sys. Guide - Eng. 0.00 25.00
234020ID Pocket PDT Brochure Nutrilite- H 0.00 15.00
234003ID PKT PDT Brochure Artistry - H 0.00 15.00
WHU9956ID Protein 4 Every - English 0.00 75.00
239187ID Eat Hard or Smart - Hindi 0.00 50.00
236703ID Adarsh Swasthya Kranti - Hindi 0.00 175.00
236702ID Optimal Health Revolution 0.00 175.00
WHU9390IDF Home Care Brochure - Hindi 0.00 40.00
230684IDD All Product Hand book - Hindi 0.00 75.00
242264ID Nut. Bone Health 0.00 50.00

Total Amount
Distributor No. .......................................................
PLEASE TICK : CONTRIBUTION TO AOF Re. 1/- YES 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

Locality

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) Mobile

STD CODE PHONE NO. STD CODE PHONE NO.

* Fields are mandatory.

IF YOUR PAYING BY CASH AND OF RS. 500/- OR RS. 1000/- DENOMINATION PLEASE FILL THE BELOW PART
NOS. OF NOTES :-
1 ________________ 5 ________________ 9 _________________ 13 ________________ 17 _______________ 21 _______________
2 ________________ 6 ________________ 10 ________________ 14 ________________ 18 _______________ 22 _______________
3 ________________ 7 ________________ 11 ________________ 15 ________________ 19 _______________ 23 _______________
4 ________________ 8 ________________ 12 ________________ 16 ________________ 20 _______________ 24 _______________