Amway India Enterprises Pvt. Ltd. DISTRIBUTOR ORDER FORM

Regd. Office- Amway India Enterprises Pvt. Ltd, Ground & First Floor ,. Updated as on 06-08-14

Elegance Tower, Plot No. 8 , Jasola , New Delhi - 110025 1 PV = 76 BV ( wef. January 2014 )

DISTRIBUTOR NUMBER __________________________ PICK-UP HOME DELIVERY

DISTRIBUTOR NAME ______________________________ DATE ………………………………..

SKU NO. QTY. DESCRIPTION DAP PV AMOUNT SKU NO. QTY. DESCRIPTION DAP PV AMOUNT

248391ID BUSINESS START. GUIDE 0 0.00 PERSONAL CARE

248392ID NUMBERLESS APPL.PAD 100 0.00 E2183IDK G&H LOTION 250 ML 389 4.09

248390ID CUSTOMER RECEIPT PAD 25 0.00 E2184IDJ NATURE SHOWER. H. SOAP 250ML 373 3.91

NUTRITION & WELLNESS E5030IDK SAT 2IN1 SHAMPOO & COND. 250 ML 389 4.09

AA0089IDK BONE HEALTH WITH IPV-60 Tabs 1769 18.57 E5050IDK SAT ADV MOIST DET COND. 250 ML 389 4.09

106678IDK HAIR,SKIN&NAILS 559 5.87 E5060IDK SAT ADV DC SHAMPOO 250 ML 389 4.09

A8085ID BLACK COHOSH &SOY 1054 11.05 E5070IDP SAT. HAIR REJUV. MASQUE 150 ML 420 4.41

102046IDK TRI-IRON FOLIC 843 8.84 E6826IDK G & H BODY SHAMPOO 250 ML 389 4.09

102992IDK CONC. FRUITS & VEG.LM 1621 17.01 215358IDL PERSONA TALC POWDER 350 Gms. 189 1.99

A5985IDJ SIBERIAN GINSENG 100 Tabs 2584 27.12 216916IDL PERSONA TALC POWDER 200 Gms. 129 1.36

A8086IDK GLUCOSAMINE HCL 120 Tabs 2749 28.84 246173IDK PERSONA SOAP PRE. PACK OF 3 (75 Gms) 130 1.37

100066IDK SALMON OMEGA 60 Tab 1291 13.55 246220IDK EXTRA ADV. SR. TOOTHBRUSH ( 4 IN 1) 146 1.54

100076IDK GARLIC HEART CARE LM 60 Tab 751 7.88 241041IDK PERSONA JUNIOR TOOTHBRUSH (4 IN 1) 105 1.09

242462IDK KIDS DRINK CHOCO 961 10.09 230295IDK PERSONA CLASSIC TOOTHBRUS ( 4IN1) 83 0.96

102578IDL PROTIEN POWDER WITH GREEN TEA 500 GM 2025 21.25 215434ID SAT. ADVANCED 2IN1 SACHET 4 MLX20 100 1

107766IDK PROTEIN FAMILY PK 1KG 3070 32.21 215435ID SAT. ADVANCED DC SACHET 4 MLX20 100 1

100141IDK PROTEIN POWDER 500 Gms 1824 19.13 215436ID SAT. DETANGLER SACHET 4 MLX20 100 1

100142IDK PROTEIN POWDER 200 Gms 870 9.13 100660IDK G&H BODY SHAMPOO 60ML 124 1.3

102745IDK DAILY120TABS(LM) 2044 21.45 200760IDK GLISTER TOOTH PASTE 100 Gms 134 1.41

100260IDK DAILY60Tabs(LM) 1200 12.59 100661IDJ G&H LOTION 60ML. 119 1.25

100309IDJ TRIPLEGUARDECHINACEA.60Tabs 1422 14.92 100950IDK SWEETSHOT MINT 8 ML (MOUTH FRESHENER) 207 2.17

242461IDK KIDSCHEWABLE60Tabs 1191 12.50 ARTISTRY

101153IDK BIOC100Tabs 1164 12.21 107998ID RENEWAL PEEL 3621 38

101154IDK PARSELENIUME30Tabs 1200 12.59 104126IDQ ESS HYDRATING CLEANSER( PINK ) 1154 12.11

101419IDK NATURALB100Tabs 788 8.26 104127IDQ ESS HYDRATING TONER (PINK) 1154 12.11

105074IDK FIBER 879 9.22 104128IDQ ESS HYDRATING LOTION (PINK) 1356 14.24

100070IDJ CH BALANCE 2566 26.92 104129IDQ ESS BALANCING CLEANSER(GREEN ) 1154 12.11

109960IDK CALMAG-D 641 6.72 104130IDQ ESS BALANCING TONER (GREEN) 1154 12.11

A4302IDK KIDS CHEWABLE CALMAG 796 8.36 104131IDQ ESS BALANCING LOTION (GREEN ) 1356 14.24

A8617IDK KIDS CHEWABLE VITAMIN C 1494 15.67 107992IDP ALPHA HYDROXY SERUM PLUS 2291 24.04

A8669IDJ KIDS CHEWABLE IRON 623 6.53 111643IDP CREAMY MASSAGE 1319 13.84

100346IDK KIDS CHEWABLE CFV 1484 15.57 106399IDQ POLISHING SCRUB - A8 ESS 1145 12.01

242259IDK NUTKIDS DRINK MIXED FRUIT 961 10.09 106401IDP MOISTURE INTENSE MASQUE 1145 12.01

A8600IDK GLUCOSE HEALTH 1429 14.99 105531IDP REPLENISHING EYE CRÈME 751 7.88

100352IDK MILK THISTLE 1521 15.96 100240IDP SKIN REFINISHING LOTION 2291 24.04

114115IDK COENZYME Q10 953 10.00 106136IDR SDS FOUNDATION CAMEO 1970 20.67

104144ID VISION HEALTH WITH LUTEIN 1833 19.22 106147IDR SDS FOUNDATION SOLEIL 1970 20.67

A8058IDK MULTI CAROTENE 1236 12.97 113803ID YX PROTECTING LOTION 3391 35.58

A8004IDK SAW PALMETTO & NETTLE 2374 24.91 113804ID YX ENRICHING LOTION 3391 35.58

250959ID KIDS DRINK PINEAPPLE 961 10.09 113807ID YX PROTECTING CREAM 3391 35.58

HOME CARE 113808ID YX ENRICHING CREAM 3391 35.58

112532IDJ SA8 GELZYME 1LITRE 715 7.5 113809ID YX SERUM CONCENTRATE 3849 40.38

239815IDK PURSUE 5 LITRE 1851 19.42 113810ID YX ENRICHING EYE CRM 2383 25

116515IDJ LOC SACHET 8 ML 6 0.07 116413ID ART IDL RDIANC SPOT CORRE 2621 27.5

116516ID DISH DROP SACHET 8ML. 6 0.07 116409ID ART IDL RDIANC ILUMNTNG E 4124 43.28

110488ID DISH DROPS 1 LITRE 549 5.76 GREAT VALUE PRODUCT

E3417IDK APSA-80 1 LITRE 1054 11.05 254285IDL DYNAMITE SHAVING CREAM (PACK OF 2) 89 0.51

109859IDK LOC GLASS CLEANER 500 ML 268 2.82 230415IDK PERSONA AMLA OIL 200 ml 68 0.39

116513IDJ SA8 DELICATE 500 ML. 389 4.09 246174IDL PERSONA COCONUT OIL 500 ml 173 1

E4111IDK CAR WASH 500 ML. 255 2.68 254284ID DYNAMITE HAIR CREAM 150 gm 77 0.45

E7506IDK PURSUE DISINFECTANT 500 ML 265 2.78 254286ID DYNAMITE RAZOR 153 1.33

E8095IDK LEATHER & VINYL CLEANER 500ML 307 3.22 DYNAMITE

E0001IDK LOC MULTIPURPOSE 1LITRE 440 4.62 254288ID DYNAMITE WHITINING CREAM 293 3.07

116512IDK DISH DROP 500ML.. 339 3.55 254287IDK DYNAMITE FACE WASH 252 2.64

116511IDK LOC MULTIPURPOSE 500 ML. 267 2.8 254282IDK DYNAMITE SHAVING FOAM 284 2.97

E8393IDK ZOOM 500 ML 250 2.62 254283IDK DYNAMITE AFTER SHAVE SPLASH 344 3.62

E8945IDK PREWASH LIQUID 500ML 395 4.14 DEO-SPRAY

E8967IDK SILICONE GLAZE 500ML 494 5.18 250319IDK DYNAMITE DEODORANT 224 2.36

100949IDK APSA-80 500ML. 647 6.79 250320IDK ATTITUDE DEODORANT 224 2.36

116514IDK SA8 GELZYME 500ML. 449 4.71

239814IDK APSA -80 5 LTR. 4491 47.13

1. The above price 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 oredr form in case of Home Delivery)

Please fill up the all relevent information before you place the order.

Please present your Amway ID card or Copy of SA88 ID (Application Form )

Trademarks of Amway Corp. Ada. MI U.S.A. All rights revesered. Printed in India.

P.T.O.

Receipt (To be filled in by Cashier)

Home Delivery ORDER # DATE AMOUNT(RS.) ITZ / Cr-Dr Card / Instruments / AR / CASH Cashier's Signature

Amway

Why Carry Cash !!! Use Amway ITZ Cash Card for quick transactions at all Amway Offices and through Web on www.amway.in

Distributor's Signature

Use Amway Itz Cash Card for Quick Transactions.

ITZ A/rINSTRUMENTSCr/Dr CARD CASH

PAYMENT MODE

Page -2

SKU NO. QTY. DESCRIPTION DAP PV AMOUNT SKU NO. QTY. DESCRIPTION DAP PV AMOUNT

SATINIQUE NEW RANGE ATTITUDE

110674ID SAT RVTLSNG HAIRMASQ 240G 651 6.83 244742IDL SUNSCREEN 389 4.09

110686ID SAT SCALP TONIC 80 ML 1458 15.29 244743IDK ATT. CLEANSER DRY 362 3.8

115776ID SAT STYLING GEL 150 GM 298 3.13 244744IDK ATT.TONER DRY 362 3.8

246159ID SAT GLOSSY REPAIR 4 ML 120 1.4 244745ID ATT.MOISTURIZER DRY 546 5.72

246160ID SAT GLOS REP CONDI 4 ML 120 1.4 244746IDK ATT. CLEANSER OILY 362 3.8

246161ID SAT HAIR FAL CNTRL 4 ML 120 1.4 244747IDK ATT.TONER OILY 362 3.8

246162ID SAT DANDRUF CTRL 4 ML 120 1.4 244748ID ATT.MOISTURIZER OILY 546 5.72

246163ID SAT.2IN1 SHAM&COND SACHET 120 1.4 244749IDK FACE WASH 256 2.68

246164ID SAT 2IN1 SHAM&COND 250ML 421 4.42 244751ID FOOT CREAM 289 3.04

246165ID SAT GLOSSY REPAIR 250 ML 421 4.42 244752IDK HAND&BODY CREAM 303 3.17

246166ID SAT GLOS REP CONDI 250 ML 421 4.42 241195IDK ATTITUDE WHITENING CREAM 482 5.05

246167ID SAT HAIR FAL CNTRL 250 ML 421 4.42 248341ID MASCARA 408 4.28

246168ID SAT DANDRUF CTRL 250 ML 421 4.42 248338ID ATTITUDE BLUSHERS 458 4.8

SALES AID 248339ID ATTITUDE EYESHADOWS 458 4.8

AD0868ID 250 ML PERSONAL CARE PUMP 21 248342ID EYE LINER-BLACK 430 4.51

PCI1404A TURRET TOP CLOSURE 9 248344IDK ATTITUDE-KAJAL 366 3.84

NID1065A PISTOL GRIP SPRAYER 27 244750IDK FACE MASQUE 303 3.17

110487ID HC DISPENSER BOTTLE 19 NEW ATTITUDE LAUNCH

EAD1605ID 1L HOME CARE PUMP 46 247168ID LIPSTICK HAZEL CRUSH 252 2.64

WHU9061IDA 500ML HOME CARE PUMP 46 247170ID LIPSTICK ORCHID SPRAY 252 2.64

250674ID BODY SPONGE IVORY COLOUR WITH PET JAR 38 253936ID LIPSTICK DREAM GARNET 252 2.64

250673ID BODY SPONGE PEACH COLOUR WITH PET JAR 38 253938ID ATT. NE PEARL SHIMMER 130 1.36

204239ID P & M CAP LOCAL MFG. 45 252914ID EYE PENCIL-SMOKEY GREEN 320 3.36

BSM 252915ID EYE PENCIL-PEARL GLAM 320 3.36

232124ID EAT HARD OR SMART BROCH.-ENGLISH 50 252916ID EYE PENCIL-GOLDEN SHIMMER 320 3.36

WHU9956ID PROTEIN 4 EVERY - ENGLISH 75 252919ID ATT. LIP PENCIL C LATTE 320 3.36

239187ID EAT HARD OR EAT SMART-HINDI 50 256304ID ATT LIPGLOSS PINK BERRY 329 3.45

230684IDD ALL PRODUCT HANDBOOK-HINDI 75 256305ID ATT LIPGLOSS LUSCIOUS PLU 329 3.45

230684IDC ALL PRODUCT HANDBOOK-ENGLISH 75 256306ID ATT LIPGLOSS MIDNITE MIST 329 3.45

241030ID ART. LEARN.GUI&BEAU BK-HINDI 80 256307ID ATT LIPGLOSS ICY PINK 329 3.45

250961ID HOME CARE BROCHURE- HINDI 40 259639ID ATT COMPACT POWDER LIGHT 641 6.72

250962ID HOME CARE BROCHURE-ENG 40 259640ID ATT COMPACT POWDER MEDIUM 641 6.72

SHIP - TO - ADDRESS KINDLY MENTION SHIPPING ADDRESS INCLUDING PROPER PINCODE FOR HOME DELIVERY ORDERS.

Distributor No.___________________________________________

Ship-To-Address :_________________________________________________________________________________________________________________________

Ship-To-Address :_________________________________________________________________________________________________________________________

Locality :____________________________________________________________ District :______________________________________________________________

State :____________________________________ PIN Code :_________________ OR Name of Post Office :_________________________________________________

Land mark :__________________________________________________________

Mobile #:_________________________________ _ Consignee's Mobile #

IF YOU PAY BY CASH AND OF ₹ 500/- OR ₹ 1000/- DENOMINATION PLEASE FILL THE BELOW PART (SR NO. OF CURRENCIES ) :-

1.__________________ 2._________________ 3.___________________ 4._________________ 5._________________ 6.__________________ 7.__________________ 8.___________________

9.__________________ 10.________________ 11.__________________ 12.________________ 13._________________ 14._________________ 15._________________ 16.__________________

17._________________ 18.________________ 19.__________________ 20.________________ 21.________________ 22._________________ 23._________________ 24.__________________

25._________________ 26.________________ 27._________________ 28.________________ 29.________________ 30._________________ 31._________________ 32.__________________

33._________________ 34.________________ 35._________________ 36.________________ 37.________________ 38._________________ 39._________________ 40.__________________

41._________________ 42.________________ 43._________________ 44.________________ 45.________________ 45._________________ 47._________________ 48.__________________

Centralized Call Center No. 080-39416600

*Use AMWAY ITZ CARD for Quick Transaction*