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Mona Vie Distributor Application
* Indicates a Required Field

  This is a secure form

If you would prefer to print this application and fax it back to us.
Click Here For   Printer Friendly Version

 

* First Name:

* Last Name:

* Shipping Address:

* City, State, Zip Code:

   

* Phone:

--
   

* E-Mail Address:

* Verify E-Mail Address:

   

* Date of Birth:

  , (Must Be 18 Years or Older)
   

* Social Security Number:

--
   

* Password:

* Verify Password:

   
* Step 1 - Enroll for a Distributor Kit
Distributor Kit $39.00 + $3.50 for Shipping & Handling (Required)
After applying for your distributor kit you will receive your distributor number plus important information and instructions to get you started. The kit will contain CD's and training materials. In addition, you will be assigned a back office website where you can access it using your distributor number to listen to training calls, place orders, enroll other potential members, and be informed about upcoming meetings and events and much more.

* Step 2 - Place an Order
 

Cost

Approx
Shipping*

1 Case MV Active (4 Bottles)

$130.00

$13.00

2 Cases MV Active (8 Bottles)

$230.00

$23.00

3 Cases MV Active (12 Bottles)

$340.00

$35.00

6 Cases MV Active (24 Bottles)

$610.00

$61.00

12 Cases MV Active (48Bottles)

$995.00

$100.00

 

1 Case MV Original (4 Bottles)

$120.00

$13.00

2 Cases MV Original (8 Bottles)

$220.00

$23.00

3 Cases MV Original (12 Bottles)

$325.00

$35.00

6 Cases MV Original (24 Bottles)

$580.00

$61.00

12 Cases MV Original (48Bottles)

$955.00

$100.00

* Approximate shipping costs for UPS Ground.

* Step 3 - Enroll in Auto-Ship
Enrolling in Auto-Ship: You will remain Active by using the "Mona Vie Auto Ship" program. This insures you will never miss a commission, and will keep the product you use arriving on a regular schedule your product will be shipped every 28 days. We believe that participating in the "Auto Ship" program is one of the most important things you can do to facilitate the "Growth" of your independent Mona Vie business.
(NOTE: You Can Cancel Your Auto Ship Anytime.)

Enroll in the monthly Auto-Ship Program?    Yes  No

Step 4 - Payment Information

* Credit Card Type:

Do Not Use
Spaces or dashes.
(Example: xxxxxxxxxxxxxxxx)

* Number:

* Expiration Date:

* Security Code:

  3 - 4 Digit Code found on front or back of card.

* Billing Zip Code:

All trademarks displayed on Mona Vie products pictured on this site are the sole and exclusive property of Mona Vie.

I understand this is information to be used to setup a Mona Vie Distributorship online and I must abide by all policies and procedures that govern my Mona Vie distributorship. I give Mona Vie, Inc. permission to charge my credit card for the products I have chosen above plus shipping and handling.

* Signature:    * Date: 



 

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