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Activation + Autoship Order Form

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					                                                                                                                                      For internal use only   ID#




                                                                           Activation + Autoship Order Form
                                                                                                                                                                                IRELAND

                                                                                                                         Phone                  Fax
SPONSOR ID#                   1090258
TEAM MEMBER INFORMATION



Synergy ID Number                              First Name, Last Name or Business Entity



Date (DD/MM/YYYY)                                    Email address
SHIPPING ADDRESS




                     Name




OPTION 1 (Please check selection)

                   ACTIVATION ORDER (One Time Only)                                               AUTOSHIP ORDER (Monthly)

        240 CV V3 Activation Pack                                                                 120 CV Autoship Combo
        net 210.–                                                                                 net 99.16



        2 – ProArgi-9 Plus                                                                        1 – ProArgi-9 Plus
        4 – Bottles Mistify                                                                       2 – Bottles Mistify
        2 – Phytolife

OPTION 2 (Please check selection)

                   ACTIVATION ORDER (One Time Only)                                               AUTOSHIP ORDER (Monthly)

        600 CV Activation Pack                                                                    120 CV Autoship Combo
        net 552.18                                                                                net 99.16



        5 – ProArgi-9 Plus                                                                        1 – ProArgi-9 Plus
        10 – Bottles Mistify                                                                      2 – Bottles Mistify
        5 – Phytolife


     Alternative Option. I wish to select an option other than those listed above. I understand that I must choose these products by telephone. I also understand that the rest of this
     form must still be completed and signed to be processed.

Delivery Service (Autoship): I agree to have Synergy WorldWide Europe BV process my product selection until further notice on the first of each month and send them after
successfully charging my selected payment method. At any time I can withdraw my participation in the AutoShip Programme in written form.

Please note: Autoship orders are processed the 1st of each month. Should I desire to select another date, I can call customer service or use the online business manager.

In case I do NOT wish to participate in the AutoShip programme, I clearly marked this section above by crossing it. Only then you do not receive any products send to your shipping
address automatically. I am aware, that my right to receive commissions for the current month can only be maintained by placing a spot order with products equal or greater to 120 CV.

PAYMENT INFORMATION

       Credit Card                                                                                                  Visa         MasterCard              Laser Card
       Number
                                                                                                                 I hereby authorise Synergy WorldWide Europe BV to charge my
       Expiration                                                                                                credit/laser card for the purchase of my Activation/ Autoship Order.
   Synergy WorldWide Europe BV ("Synergy") Terms and Conditions for Team Member Participation
                                  in the Autoship Programme.


By completing and submitting the online application form I hereby apply to participate in the Autoship Programme. I understand
that Synergy will signify its acceptance of my application by email.

As an Autoship participant I understand that the terms and conditions for the purchase of Products (the "Terms") set out in the
Team Member Agreement including the Synergy Policies and Procedures shall apply to me and to any orders that are placed
individually.

As an Autoship participant by signing the attached Credit/debit card instruction form, I authorise Synergy to deduct each month
the amount that I have indicated in my application from my nominated account. I understand and agree that as an Autoship or
Autoship Elite Member (as appropriate) the funds deducted from my account will be used to pay for the Products ordered by me
(together with any applicable shipping and administration fees) each month. In the event that I choose to terminate my participa-
tion in the Autoship Programme at any time Synergy will refund to me any funds held as credit on my account. Synergy reserves
the right to make any such refund in the same form as the original payment.

I understand that if, as an Autoship participant, I wish to change the amount of my monthly payment I must submit to Synergy by
email, fax or post an amendment request/form showing all appropriate revisions. In order to be effective any amendment
request/form showing a change to a monthly payment by an Autoship participant must be received by Synergy no later than 3
days prior to the usual monthly payment date.

In the event that Synergy does not receive cleared funds in respect of any one individual order then it shall not be obliged to
despatch any Products to me in respect of that order and may, if it so wishes, treat my status as an Autoship participant as
terminated. If Synergy does not receive cleared funds in respect of the monthly payment by me then it shall not be obliged to
despatch any Products ordered and Synergy shall be entitled to treat my Autoship account and participation as terminated,
unless I have a credit balance on my account with Synergy sufficient to cover the value of any order.

If for any reason my Credit/debit card payment is declined or cancelled and the Product has been shipped to me I am liable either
to return the Product unopened or settle the full amount due within 3 days of notice by Synergy.

I understand that my Autoship Programme order will remain in effect until:

1. I submit an amendment request/form; or

2. I send in writing email, fax or post my cancellation of my Autoship or Autoship Elite Member (as appropriate) status, in a form
notified to me from time to time, such cancellation to include my name and signature (as applicable) such cancellation being
effective for the month following the month in which the cancellation was received by Synergy; or

3. I inform my Credit/debit card company to stop paying the credit/debit card payment and to inform Synergy five days before the
date scheduled for the next payment to be withdrawn; or

4. Synergy decides to terminate this Agreement for any reason whatsoever including but not limited to a payment not being
made); or

5. either Synergy or I decide to terminate my Team Member Agreement.

I understand that I have a right to cancel immediately my Autoship or Autoship Elite Programme (as applicable) order and any
other orders placed by me as an Autoship or Autoship Elite Member (as appropriate) and any variations to orders in accordance
with the Terms.

I acknowledge that I have been provided with notice of my cancellation rights.
                                                                                                                  How To Fill In An Activation & Autoship Form
   !"#$%&#"'(
)*+$($*+$*,%%,$-.%%.$./$#0                                                                                        “V3 Products”

                                                                                                                                                                                                                           Application Information & Shipping Address
                                                                                                                                                 OFFICE USE ONLY       ID#
                                                                                                                                                                                                                           Fill in the information of the new member in here. One of the most
                                                                                                                                                                                                                           important pieces of information to provide in this section is the
                                                                              Activation + Autoship Order Form (V3)                                                                                                        telephone number.
                                                                                                                                                                                    IR E L A N D

                                                                                                                            Phone                    Fax

       TEAM MEMBER INFORMATION



       Synergy ID Number                              First Name, Last Name or Business Entity
                                                                                                                                                                                                   1                       Activation Order
       Date (DD/MM/YYYY)                                    Email address                                                                                                                                                  In this section, if the customer wishes to be involved in Synergy solely
                                                                                                                                                                                                                           as a product consumer then you will just need to place an       X
                            Name

                                                                                                                                                                                                                           through the activation box and a         for the autoship option as they
                                                                                                                                                                                                                           will now just receive their product every month. Fill in their order for




       SHIPPING ADDRESS
                                                                                                                                                                                                                           what they would like to receive on a monthly basis. You still need to
       OPTION 1 (Please check selection)
                                                                                                                                                                                                                           fill in the Getting Started form in order to get the products at distrib-
                          ACTIVATION ORDER (One Time Only)                                               AUTOSHIP ORDER (Monthly)
                                                                                      X                                                                                                                                    uter prices. If its a business builder just simply     the activation
               200 CV V3 Activation Pack                                                                 120 CV Autoship Combo
               net 180.--                                                                                net 99.16                                                                                                         order box.
               2 – ProArgi-9 Plus                                                                        1 – ProArgi-9 Plus
                                                                                                                                                                                                   2
               2 – Bottles Mistify                                                                       2 – Bottles Mistify
               2 – Phytolife                                                                                                                                                                                               Payment Information
       OPTION 2 (Please check selection)

                          UPGRADE ORDER (One Time Upgrade Order)                                                                                                                                                           In the payment section, fill in the payment options to correspond with
               400 CV V3 Upgrade Pack
               net 359.--
                                                                                                                                                                                                                           how the customer will be paying for their products each month. A
                                                                                                                                                                                                                           Laser card will have 3 extra digits.
               4 – ProArgi-9 Plus
               4 – Bottles Mistify
               4 – Phytolife


            Alternative Option. I wish to select an option other than those listed above. I understand that I must choose these products by telephone. I also understand that the rest of this
            form must still be completed and signed to be processed.                                                                                                                                                      One signature is requested on
       Delivery Service (Autoship): I agree to have Synergy WorldWide Europe BV process my product selection until further notice on the first of each month and send them after
       successfully charging my selected payment method. At any time I can withdraw my participation in the AutoShip Programme in written form.                                                                           an Activitation & Autoship Form
                                                                                                                                                  e
       Please note: Autoship orders are processed the 1st of each month. Should I desire to select another date, I can call customer service or use the online business manager.

       In case I do NOT wish to participate in the AutoShip programme, I clearly marked this section above by crossing it. Only then you do not receive any products send to your shipping
       address automatically. I am aware, that my right to receive commissions for the current month can only be maintained by placing a spot order with products equal or greater to 120 CV.

       Activating with 3 Tracking Centers: Selecting Option 1 and Option 2 will activate your position with 3 Tracking Centers.
                                                                                                                                                                                                       Submit The Form To Either Of The Below Contact Addresses
       PAYMENT INFORMATION

              Credit Card                                                                                                  Visa         MasterCard             Laser Card
              Number
                                                                                                                        I hereby authorise Synergy WorldWide Europe BV to charge my                    Tel:    01 247 6110            Fax:     01 247 6111
              Expiration                                                                                                credit/laser card for the purchase of my Activation/ Autoship Order.
  3                                                                                                                                             Signature Required                                     Or Alternatively Scan & Email To: eucustomerservice@synergyworldwide.com
                                                                                                                                                                                                       Make sure to get the forms submitted within 2-3 days of contact with the company.



                                   Visit the Synergy Core Group webinar for more information regarding                                                                                                                          www.bestcoresolutions.com
                                                    Synergy’s business model and amazing V3 products :

				
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posted:4/28/2010
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