CLIENT INFORMATION, SKIN CARE QUESTIONNAIRE AND ORDER FORM

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CLIENT INFORMATION, SKIN CARE QUESTIONNAIRE AND ORDER FORM Powered By Docstoc
					 ________________________________________________________________________________________ _________________________________________
 Client Name – Please Print                                                                                                                                 Today’s Date
                                                                                                                                                   SHIPPING & HANDLING
 ________________________________________________________________________________________ _________________________________________
 Address                                                                                                                                                   SUBTOTAL
                                                                                                                                                              Hostess Name

 _________________________________________                            ________________________                _________________ _________________________________________
 City                                                                              State                             Zip                                       TAX 6%
                                                                                                                                                         SALES My Birthday
 ___________________________________________________________________________________________________________________________________
                                                                                                  LESS DISCOUNT(S)
 Email Address

 _________________________________________                                                                              LESS HOSTESS CREDIT
                                                                      ____________________________________________ _________________________________________
 Home Phone                                                                                     Cell Phone                                                      Best Time to Call

Please fill in box above and answer these questions for entry in our door prize drawing!
                                                                                                                                                                      Your Spa Consultant:
Do you work?                  full-time                  part-time                domestic goddess                         student
                                                                                                                                                              Heather Richter-Egger
Can you use an extra $600-$1000 a month?                                          YES                        NO
         If so, what would you do with it? _______________________________________                                                                                  (402) 553-7246
What intrigued you the most about tonight's spa experience?                                                                                                               hmre@cox.net
         _________________________________________________________________                                                                                     www.beautipage.com/hrichteregger

Would you like to find out more information about BeautiControl? YES NO                                                                                               Please call me with any
                                                                                                                                                                     questions you may have!
Would you like to host your own spa? YES (Theme:________________)                                                          NO          Maybe
 Filled                                                       ITEM DESCRIPTION                                                         QTY                PRICE EACH                       TOTAL
  Shipped                                                                                                                                                     $125
directly from                  BC Spa BeautiCase (Up to a $390 value)                                                                    1
  company                                                                                                                                                (+ 18 s/h & tax)
  Shipped                                                                                                                                                     $385
directly from                  BC Spa Business Case              (Up to a $1200 value)                                                   1
  company                                                                                                                                                (+ 25 s/h & tax)
                        Black Spa Bag with $80 Purchase                                                                                  1                      FREE




                        Add on Skin Care Starter Set with any Purchase (system:___________________)                                                            $10.00

                                 Thank you for your order…I offer three easy ways to pay:                                                               PRODUCT TOTAL                  $

                                                                                                                                                    Shipping & Handling                +
        Cash                                    Check #__________                 Payable to:          _______________________
                                                                                                                                                          7% Sales Tax                 +
        Credit Card (Select One):                 VISA          MASTERCARD                 DISCOVER             AMEX
                                                                                                                                                            Discounts                  -

Credit Card #__________ / __________ / ___________ / ____________ Exp Date_______ /________                                                             Hostess Credits                -

                                                                                                                                                                                       -
AVS #______________________________Billing Zip_________________
                                                                                                                   For office use only
                                                                                                                   Credit Card Processed                   Order Total                 $
Signature____________________________________________________

                                                This section only to be completed if choosing one of the BC Spa Cases above:

Skin care Set:                 20's        30's          40's        50+           Acne         Sensitive                                           SSN**: _________/_______/__________

Mineral Make-up set:                       AuNatural / P2            Wisteria Lane / N3               Passion / N5                                  BIRTH DATE: ______/_______/______
( ) I understand that I will receive the Mineral Make-up set as part of my BONUS PACK                                                               BeautiU Seminar Date :_____________
           after attending the BeautiU Seminar within 90 days of my start date.
                              **Your privacy is our policy. BeauutiControl software ensures the security of SSN, which is required to allow you to buy products at wholesale prices.