1. VISALUS ™ CUSTOMER APPLICATION Fax Form to 1.877.547.1570
FIT KIT NEW SHAPE KIT
$299 Auto-Ship
Price
$99 Auto-Ship
Price
$409 Retail Value SAVE $110 $136 Retail Value SAVE $37
Supports athletic performance. Shape your body.
Benefits: 60 Full Meals! Benefits: 60 Full Meals!
• Healthy energy, stamina, endurance • Two shakes per day for faster results
• Supports lean muscle • Includes samples of each of our Shape-Up™
Health Flavor Mix-Ins
TRANSFORMATION KIT BALANCE KIT
$249 Auto-Ship
Price
$49 Auto-Ship
Price
$339 Retail Value SAVE $90 $68 Retail Value SAVE $19
Ultimate shaping and nutrition support. Balance your nutrition daily.
Benefits: 60 Full Meals! Benefits: 30 Full Meals!
• Comprehensive support for your goals • The shake mix that tastes like a cake mix™
• Appetite and metabolism support • Proprietary Tri-Sorb™ protein blend
• Supports lean muscle and the body’s fat burning process • Supports digestive, heart and bone health
• Supports digestive, heart and bone health • Includes samples of Shape-Up™ Health Flavor Mix-Ins
CORE KIT Add Vi-pak® Only $99
$199
to your kit
Auto-Ship
(Auto-Ship Only)
Price
$278 Retail Value SAVE $79
Support your active lifestyle.
Benefits: 30 Full Meals!
• Energy, stamina and hydration NEW! Yes! Auto-Ship My Order.
• Molecularly-distilled Omega Oils ViSalus GO™
• Chelated Multi-Mineral & Vitamin
Check one date:
ViSalus PRO™
• Supercharged Antioxidant with a powerful blend of 26 of nature’s richest sources
• Patented Anti-Aging & Energy formula 5th 12th 19th
• Contains ViSalus NEURO® for healthy energy and Shape-Up™ Health Flavor Mix-Ins
Add nutra-cookies™ Only $34/box Add New ViSalus GO™ Add New ViSalus PRO™
to your order Auto-Ship Price to your order to your order
Chocolate
Chip
Oatmeal
Raisin
Peanut
Butter Only $48/box Only $32/box
Auto-Ship Price Auto-Ship Price
3 FOR free
To qualify for your FREE Kit, the 3 (or more)
orders must be Challenge Kit Customers
(not Promoters) with a total sales volume SCHEDULE MY
of at least three times that of your
personal Challenge Kit. All 3 orders must CHALLENGE
As a Body by Vi™ Challenge Kit Customer or Promoter, simply use
your ID # and your personal BodyByVi.com website to refer at least
be on Auto-Ship, and be placed within the
same calendar month. Limited to one free
Kit per person per month. Tax, shipping
PARTY FOR
3 other Customers to a Challenge Kit and you could get your Kit for and handling still apply. Date:
free next month.
Customer Shipping Information: Customer Billing Information:
Last Name:________________________ First Name:_______________________ Full Name on Credit Card:____________________________________________
Shipping Address:___________________________________________________ Billing Address:__________________________________________________
Apt/Suite:_______________________________________________________ Apt/Suite:_____________________________________________________
City: ___________________________ State:_______ Zip:_______________ City: ___________________________ State:_______ Zip:_____________
Daytime Phone #:___________________________________________________ Credit Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
E-mail Address:____________________________________________________ Expiration Date:_____________________ Security Code:___________________
▢ Yes, I would like to receive communications from ViSalus™ regarding special discounts Card Type: ▢ Visa ▢ MasterCard ▢ Discover ▢ American Express
and promotions.
Cardholder Signature:______________________________________________
Fill in the Name and ID number of the ViSalus Customer or Promoter signing you up today:
I authorize ViSalus to charge my account for the amount listed. I promise to pay such amount
Last Name:________________________ First Name:_______________________ to and in agreement governing the use of such card. I understand that ViSalus will apply taxes,
shipping and handling charges to my order. If order is Auto-Ship, I authorize ViSalus to ship
these products monthly. Cancellations must be submitted 5 days prior to the Auto-Ship date.
ID # or SSN:______________________________________________________
1607 E. Big Beaver Rd. Suite #110, Troy, MI 48083 • Customer Service 1.877.VISALUS • vi.com
© 2012 ViSalus, Inc. All rights reserved. D1053US-08

2. PROMOTER SYSTEMS
BECOME A VISALUS™ INDEPENDENT PROMOTER AND START EARNING MONEY & REWARDS
when you help people join The Challenge and become Challenge Promoters like you!
49
The basic information you need to start promoting The Challenge!
$
+ PURCHASE YOUR
CHALLENGE KIT
x3
FROM $49–$299
499
Experience the most popular Challenge Kit products. Promote The Challenge with premium promoting materials
and samples. Access Exclusive SUCCESS Entrepreneurship & Leadership Audios. And…Jump-start your way to $
Rising Star & Bimmer Club reward opportunities.
x15
VISALUS TM
25% off
Executive Promoter System required to participate in Rising Star & BMW Programs.
TOTAL RETAIL VALUE $ 1,897
The fastest way to become a Rising Star! Enjoy all of the components of the Executive Promoter System…PLUS –
999
arm yourself with additional promoting materials, and Taster & Starter Packs to give those you know a real taste
of what The Challenge is all about! $
x40
x10
25% off
FREE
25% off VISALUS TM
x25 x25 x10
1607 E. Big Beaver Rd. Suite #110, Troy, MI 48083 • Customer Service 1.877.VISALUS • vi.com
© 2012 ViSalus, Inc. All rights reserved. D1028US-16

3. VISALUS ™ INDEPENDENT PROMOTER (VIP) APPLICATION Fax Form to 1.877.547.1570
STEP 1: Join Our Team. Please choose an enrollment option. PROMOTER SYSTEMS
$ 49 $499 x40
$ 999
x15 TOTAL RETAIL VALUE
$ 1,897
x10
25% off
x3 25% off 25% off FREE
+ PURCHASE YOUR
CHALLENGE KIT VISALUS TM
VISALUS TM
FROM $49–$299 x25 x25 x10
2 STEP 2: Select Your Monthly Challenge Kit. Choose the items you would like shipped to you each month.
NEW CHOOSE YOUR AUTO-SHIP DATE:
5th 12th 19th
Executive enrollment Auto-Ship orders
will be processed and shipped starting
the next month on the selected date. 30 Children’s SHAKE
Basic enrollment Auto-Ship orders will
be processed and shipped with your Meals Donation $24
FIT KIT TRANSFORMATION KIT CORE KIT SHAPE KIT BALANCE KIT enrollment package. If selected date AUTO
lands on a weekend or holiday, orders QTY: SHIP
$299 $249 $199 $99 $49
$409 Retail Value $339 Retail Value $278 Retail Value $136 Retail Value $68 Retail Value will be processed on the last business
SAVE $110 SAVE $90 SAVE $79 SAVE $37 SAVE $19 day prior. Shake Meal for Meal Match!
2 STEP 3: Additional Products 2 STEP 4: Vi-Net® Login & Additional Tools
All additional product orders will be processed and shipped with your enrollment package. Please select a unique username and password to access your ViSalus Back Office.
QTY ITEM NAME ITEM PRICE AUTO-SHIP ONE-TIME QTY ITEM NAME ITEM PRICE AUTO-SHIP ONE-TIME If neither Username choice is available, Passwords must have 6–16 characters
username will default to your mailbox and contain at least one letter and one
50 Taster Packs $250 Nutra-Cookie™: Pick a Flavor number. number, e.g., rsmith2.
25 Starter Packs $250 (1st Choice):
Oatmeal Raisin $34/box
(2nd Choice):
ViSalus GOTM–2 oz. Shots $48/box Peanut Butter $34/box
ViSalus PROTM–Drink Mix $32/box Chocolate Chip $34/box You will automatically be Upgrade to Vi-Net Pro
subscribed to Vi-Net Pro Swipe for $39/mo and
Vi-pak® $99 plus ViSalus Success Club get The Swiper for $49
Subscription for $29/mo. (one time charge)
See Product Price Sheet for Item Numbers and pricing information. To change or cancel, call ViSalus Customer Service at 1.877.VISALUS
2 STEP 5: Personal Information
IP# or SSN:____________________________________________________ Communication Preferences:
Enroller Last Name:___________________ First Name:_______________________ Home Phone #:_____________________ Mobile Phone #:________________
The Enroller is an existing IP who refers a new IP. The Enroller can place the new IP anywhere in the depth of his/her organization.
Once the enrollment process is complete the enroller can add/change sponsor information in the “Waiting Room” found in Vi-Net. Mobile Phone Provider: Required for ViSalus Mobile Updates (SMS)____________________
E-mail Address:________________________________________________
Last Name:_______________________ First Name:______________________
Receive ViSalus News & Updates via: Check at least one
SSN or Tax ID:______________________ Birth Date: ____/ ____/______
▢ Phone ▢ Email ▢ Mobile Text Message (SMS) ▢ None
Company Name:___________________________________________________
If doing business as a legal entity, complete and attach the Company Enrollment Form. (Required)
Language Preference: ▢ English ▢ Spanish ▢ Both
Gender: ▢ Male ▢ Female
Shipping/Mailing Address:___________________________________________
Billing Information:
Apt/Suite:_______________________________________________________
Full Name on Credit Card:__________________________________________
City: ___________________________ State:_______ Zip:_______________
Credit Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Billing Address:___________________________________________________ Expiration Date:_____________________ Security Code:_________________
Apt/Suite:_______________________________________________________ Card Type: ▢ Visa ▢ MasterCard ▢ Discover ▢ American Express
City: ___________________________ State:_______ Zip:_______________ Cardholder Signature:____________________________________________
I authorize ViSalus to charge my account for the amount listed. I promise to pay such amount to and in agreement governing the use of such card. I understand that ViSalus will apply taxes, shipping and handling charges to my order. If the
order is Auto-Ship or a monthly Vi-Net Subscription, I authorize ViSalus to ship/charge these products monthly. Cancellations must be submitted at least 5 days prior to the Auto-Ship date or Vi-Net billing date.
I understand that to become an Independent Promoter (IP) of ViSalus I am only required to submit this Agreement. receipt of this Agreement. I have read and understand ViSalus’ Policies and Procedures and Compensation Plan,
I further acknowledge that my advancement in the ViSalus marketing plan is based solely upon the acquisition of which are incorporated by the reference herein, and agree to abide by them as they may be amended at any time.
customers. My purchase of sales aids or training material, or attendance at training classes, is strictly optional and
at my discretion. I also understand that if I choose to enroll or sponsor other individuals to participate in ViSalus’ I UNDERSTAND THAT I MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION AT ANY TIME,
marketing plan, I will only be compensated based upon the activities of other IPs to the extent of their sales made
to customers. FOR ANY REASON. I UNDERSTAND THAT MY NOTICE OF CANCELLATION MUST BE SUBMITTED IN WRITING TO
By my signature below and initials on the IP Terms of Agreement on the reverse side, I acknowledge that I have THE COMPANY AT ITS PRINCIPAL BUSINESS ADDRESS. PLEASE SEE OTHER SIDE FOR TERMS.
carefully read this Agreement, and I am willing to accept the terms and conditions herein and on the reverse side.
I understand that the terms of this document shall be a binding Agreement between ViSalus and me and upon
Applicant Signature: X Date:
This application is not considered complete unless ViSalus receives both the signed and dated Application (page 1) and the initialed Terms of Agreement (page 2)
1607 E. Big Beaver Rd. Suite #110, Troy, MI 48083 • Customer Service 1.877.VISALUS • vi.com
© 2012 ViSalus, Inc. All rights reserved. D1000US-25 1/2

4. VIP TERMS OF AGREEMENT Fax Form to 1.877.547.1570
By joining ViSalus™ these are the Terms you have agreed to. Refer to the from VISALUS without written authorization and that the unauthorized use
Policies and Procedures for detailed information. of any Proprietary Mark is a violation of federal law and this Agreement,
1. I acknowledge that I am of legal age to enter into this Agreement and that constituting grounds for termination of this Agreement by VISALUS.
I am a real person. 16. I understand that as a Promoter, I am free to select my own means,
2. I understand and acknowledge that this Agreement is not binding until methods and manner of operation and that I am free to choose the hours
received and accepted by VISALUS. and location of my activities under this Agreement, subject only to the
terms of this Agreement and VISALUS Policies and Procedures.
3. I agree that as a Promoter, I am responsible for determining my own
business activities and that I am not an agent, employee or legal 17. I acknowledge that I am not guaranteed any income nor am I assured
representative of VISALUS. I am responsible for the payment of all federal any profits or success. I certify that no claims of guaranteed profits or
and state employment taxes and any other tax required under any federal, representations of expected earnings that might result from my efforts have
state or regulatory law. In the event that I fail to provide VISALUS a valid been made by VISALUS or any VISALUS Promoters. In this connection, I
Social Security Number or employer identification number, VISALUS may shall not represent directly or indirectly that any person may, can or will
withhold commissions due to me until a valid number is provided. earn any stated gross or net amount, nor that sponsorship of others is easy
to secure or retain, or that substantially all Promoters will succeed.
4. I understand that I am not being sold a franchise or business opportunity.
18. I acknowledge that I have the right to sign up as many personal customers
5. I may terminate this Agreement for any reason, at any time, by giving as I wish. I will receive a commission each month from my personal
VISALUS prior written notice. VISALUS may terminate this Agreement in customers’ purchases and my downline network in accordance with the
writing upon violation of policies and procedures or in the event I violate VISALUS Compensation Plan then in effect.
any part of this Agreement. In such event, no further commissions will
be paid by VISALUS. To terminate this Agreement, I must mail or deliver 19. I agree to indemnify and hold harmless VISALUS from any and all claims
personally to VISALUS, a signed, dated written notice of cancellation sent losses, damages and expenses, including any attorney’s fees, arising out
to: ViSalus, 1607 East Big Beaver, Suite 110, Troy, Michigan 48083. of my actions or conduct in violation of this Agreement, Compensation Plan
or any Policy or Procedure of VISALUS. I agree that in order to recoup any
6. I agree that as a VISALUS Promoter, I shall place primary emphasis damages and expenses it has incurred due to such violation(s), VISALUS
upon the sale of Products and Services to non-Promoter consumers as may offset any commissions or other payments due me. In the event a
a condition of my receipt of commissions. Commissions I receive will dispute arises as to the respective rights, duties and obligations under this
be based upon fulfilling certain terms of qualification as set forth by Agreement, Compensation Plan or the Policies and Procedures of VISALUS,
the Marketing Program and Compensation Plans as may be amended it is agreed that such disputes shall be exclusively resolved in the Circuit
from time to time. A three ($3.00) Dollar processing fee will apply to all Court for Oakland County, State of Michigan, or Federal Court located in
payments. Detroit, Michigan. Michigan law shall apply to the resolution of all disputes.
7. I agree to keep accurate records and to abide by all federal, state, and Louisiana residents may choose Louisiana law and jurisdiction.
local laws and regulations governing the sale or solicitation of the products 20. I acknowledge that I have read and fully understand the VISALUS Policies
and services marketed by VISALUS including, but not limited to, any and all and Procedures and Compensation Plan, which are incorporated herein
permits and licenses required to perform under this Agreement. by reference and are binding upon me. In order to maintain a viable
8. I understand that no attorney general or other regulatory authority ever marketing program and to comply with changes in federal, state or local
reviews, endorses, or approves any product, subscription, compensation laws or economic conditions, VISALUS may revise its Compensation Plan
program or company, and I will make no such claim to others. and Policies and Procedures from time to time. All changes thereto shall be
9. I understand that a $25 Administration Fee will be charged annually to my effective upon verbal or written notice to me and become a binding part of
credit card on file with ViSalus. This fee is for services, which include, but this Agreement. The home office prior to use or publication must approve
are not limited to, downline reporting, customer tracking and accounting all advertisements using the Proprietary Marks of VISALUS.
services. The Administration Fee will be charged in the month of my 21. I acknowledge that this Agreement, Compensation Plan and the Policies
enrollment anniversary and if not paid will result in my Promotership and Procedures incorporated herein by reference, constitute the entire
being placed on Financial Hold for up to 120 days. If the Administration Agreement between the parties and shall not be modified or amended
Fee remains unpaid 120 days after it was due, my Promotership will be except in writing signed by VISALUS. This Agreement shall be binding upon
terminated and I will forfeit any commissions that were held since the and inure to the benefit of heirs, successors, and permitted assigns of the
time I was placed on Financial Hold. If my Promotership is terminated, I parties hereto. If any provision of the Agreement is determined by any
understand that I must re-enroll as a brand new Promoter and will not be authority of competent jurisdiction to be invalid or unenforceable in part or
placed back in my original spot if I wish to pursue the ViSalus opportunity. in whole for any reason whatsoever, the validity of the remaining provisions
10. I agree that VISALUS shall not be liable under any circumstances for or portions thereof shall not be affected thereby.
any damage or loss of any kind, including indirect, special, punitive, 22. I agree to abide by the terms of the noninterference and non-disclosure
compensatory, or consequential damages, losses or profits which may policy of VISALUS.
result from any cause, including but not limited to, breach of warranty, 23. During the term of this Agreement (and any renewals), I will not sell
delay, act, error or omission of VISALUS, or in the event of discontinuation any other products for any entity competing with VISALUS. I agree that
or modification of a product or service offered by VISALUS. I no longer promote any other organization that utilizes a multi-tiered
11. VISALUS shall periodically make sales literature and/or promotional compensation plan.
materials available. However, I am under no obligation to purchase any 24. During the term of this Agreement (and any renewals) and for one (1) year
materials or literature at any time. Refunds shall not be allowed under any thereafter, I understand and agree that I will not contact, solicit, or recruit
circumstances, including, but not limited to, termination of this Agreement, any VIP, whether active or inactive, into any organization that utilizes a
obsolescence of such sales literature or promotional materials, or any other multi-tiered compensation plan. This includes indirect recruiting through
reason. Except as specified in paragraph 26. Facebook or other social media. I acknowledge that my violation of this
12. I agree that as a Promoter, this Agreement grants me the limited authority provision will result in immediate termination of my Promotership and
to promote and sell the products VISALUS markets subject to the terms and payments of any kind.
conditions established by VISALUS. 25. I understand that if for any reason a VIP violates any of the terms of the
13. I will not make any false or misleading statements about VISALUS or Agreement and/or these Policies and Procedures, ViSalus reserves the
its marketing program. I agree that I will operate in a lawful, ethical right to immediately deactivate or terminate the VIP’s position. Such action
and moral manner and will not engage in or perform any misleading, by ViSalus will terminate any and all rights of the VIP and any further
deceptive or unethical practices. In the event I violate any of these payments of any kind and is effective at the time of said violation.
conditions, my position may be terminated without further payment or 26. ViSalus Executive and Business Opportunity Return Policy: An Independent
compensation of any kind. Promoter who cancels their Promotership within 30 days of enrollment may
14. I acknowledge that I am responsible for supervising and supporting return unused products from the Promoter Systems which are unopened
Promoters I sponsor into the program and in my commissionable network. I and in resalable condition. A refund will be issued for the value of the
agree to maintain monthly communication and support to those individuals Business Opportunity ($49) and the value of unused and saleable products
in my commissionable network through written or verbal communication up to $450. If an Independent Promoter cancels their Promotership within
and attendance at meetings. their first year but more than 30 days after their enrollment date, the same
15. I acknowledge that VISALUS expressly reserves all proprietary rights to guidelines apply however returned, saleable products will result in a
the company’s trademarks, tradenames, logos (“Proprietary Marks”) and product credit equal to the discounted value of those products (up to $450)
copyrighted materials. I understand, acknowledge and agree that any rather than a refund and will be subject to a restocking fee.
monies which I pay VISALUS are in consideration of my receiving a non-
exclusive license, during the term of this Agreement to use the Proprietary
Marks of VISALUS as stipulated in the Policies and Procedures and in Please initial here_________ to acknowledge that you have read and
conjunction with the marketing program provided to me. I further agree agree to the above Terms of Agreement. Your application is not complete
that I will not use VISALUS’s Proprietary Marks in any form whatsoever unless you initial this page and submit with your Independent Promoter
except as permitted in writing by VISALUS or in advertising or promotion Application.
materials provided, designed or published by VISALUS. I understand that
I may not photocopy or duplicate any materials provided by or purchased
1607 E. Big Beaver Rd. Suite #110, Troy, MI 48083 • Customer Service 1.877.VISALUS • vi.com
© 2012 ViSalus, Inc. All rights reserved. D1000US-25 2/2

5. 1607 e Big Beaver rd Suite #110, troy, mI 48083
Product Order Form Customer Service 1.877.VISALUS
Fax Form To: 877.547.1570
Balance Kit $49
Auto-Ship Price
Shape Kit $
99
Auto-Ship Price
Core Kit $
199
Auto-Ship Price
Save $19 off retail prices Save $37 off retail prices Save $79 off retail prices
1 Pouch Vi-Shape® 2 Pouches Vi-Shape® 1 Vi-pak® (30 daily AM/PM packets)
Nutritional Shake Mix Nutritional Shake Mix 1 Pouch Vi-Shape®
5 Packets Shape-Up™ 10 Packets Shape-Up™ Nutritional Shake Mix
Health Flavor Mix-Ins Health Flavor Mix-Ins 5 Packets Shape-Up™
Health Flavor Mix Ins
2 Boxes ViSalus NEURO™: 1 each
Add the full Vi-pak®
to your Challenge Kit (Auto-Ship Only) Only $99 Raspberry Boost & Lemon Lift
Transformation Kit $
249 Fit Kit $
299
Auto-Ship Price Auto-Ship Price
Save $90 off retail prices Save $110 off retail prices
2 Pouches Vi-Shape® Nutritional Shake Mix 2 Pouches Vi-Shape® Nutritional Shake Mix
10 Packets Shape-Up™ Health Flavor Mix-Ins 5 Packets Shape-Up™ Health Flavor Mix-Ins
1 Bottle Vi-Slim® Metab-Awake! Tablets 2 Boxes ViSalus PRO™ Prolonged Energy Drink Mix
1 Box Vi-Trim® Clear Control Drink Mix 2 Boxes ViSalus GO™ Instant Energy Drink
1 Bottle Omega Vitals Supplement 30 ViSalus Nutra-Cookies™: 10 each flavor–
2 Boxes ViSalus NEURO™: 1 each Raspberry Boost & Lemon Lift Chocolate Chip, Oatmeal Raisin, and Peanut Butter
Item No. ProDUCt DeSCrIPtIoN WHoLeSALe retAIL qty totAL AUto-SHIP
K0020 Body by Vi Balance Kit
™
$49 $61 ▢ 5 ▢ 12TH ▢ 19TH
TH
K0021 Body by Vi Shape Kit
™
$99 $124 ▢ 5TH ▢ 12TH ▢ 19TH
K0019 Body by Vi™ Core Kit $199 $249 ▢ 5TH ▢ 12TH ▢ 19TH
K0015 Body by Vi™ Transformation Kit $249 $311 ▢ 5TH ▢ 12TH ▢ 19TH
K0048 Body by Vi™ Fit Kit $299 $374 ▢ 5TH ▢ 12TH ▢ 19TH
Add Vi-pak® to your Challenge Kit (Auto-Ship only) $99 n/a ▢ 5TH ▢ 12TH ▢ 19TH
N1210 Vi-Shape® Nutritional Shake Mix (30 Serving Pouch) $45 $59 ▢ 5TH ▢ 12TH ▢ 19TH
N1211 Vi-Shape® Nutritional Shake Mix (15 Individual Packets) $28 $36 ▢ 5TH ▢ 12TH ▢ 19TH
N1227 Nutra-Cookie™ Chocolate Chip (14 Individually Wrapped Cookies) $34 $40 ▢ 5TH ▢ 12TH ▢ 19TH
N1228 Nutra-Cookie™ Oatmeal Raisin (14 Individually Wrapped Cookies) $34 $40 ▢ 5TH ▢ 12TH ▢ 19TH
N1229 Nutra-Cookie™ Peanut Butter (14 Individually Wrapped Cookies) $34 $40 ▢ 5TH ▢ 12TH ▢ 19TH
K0029 Nutra-Cookie™ Chocolate Chip 4-Pack (4 boxes) $125 $150 ▢ 5TH ▢ 12TH ▢ 19TH
K0030 Nutra-Cookie™ Oatmeal Raisin 4-Pack (4 boxes) $125 $150 ▢ 5TH ▢ 12TH ▢ 19TH
K0028 Nutra-Cookie™ Variety 4-Pack (2 boxes each Chocolate Chip and Oatmeal Raisin) $125 $150 ▢ 5TH ▢ 12TH ▢ 19TH
N1212 Vi-Slim® Metab-Awake! Tablets (30 Tablets per Bottle) $40 $50 ▢ 5TH ▢ 12TH ▢ 19TH
N1213 Vi-Trim® Clear Control Drink Mix (30 Individual Packets) $40 $50 ▢ 5TH ▢ 12TH ▢ 19TH
N1214 Shape-Up™ Health Flavor Mix-In Strawberry (15 Individual Packets) $10 $12.50 ▢ 5TH ▢ 12TH ▢ 19TH
N1215 Shape-Up™ Health Flavor Mix-In Chocolate (15 Individual Packets) $10 $12.50 ▢ 5TH ▢ 12TH ▢ 19TH
N1216 Shape-Up™ Health Flavor Mix-In Banana (15 Individual Packets) $12 $15 ▢ 5TH ▢ 12TH ▢ 19TH
N1217 Shape-Up™ Health Flavor Mix-In Peach (15 Individual Packets) $12 $15 ▢ 5TH ▢ 12TH ▢ 19TH
N1218 Shape-Up™ Health Flavor Mix-In Orange (15 Individual Packets) $12 $15 ▢ 5TH ▢ 12TH ▢ 19TH
K0010 Health Flavor Mix-In Variety 5–Pack (1 box of each flavor) $50 $63 ▢ 5TH ▢ 12TH ▢ 19TH
N1002 Vi-pak® (30 Daily AM/PM Packets) $125 $150 ▢ 5TH ▢ 12TH ▢ 19TH
N1225 ViSalus Pro™ Prolonged Energy Drink Mix – Passionfruit (15 packets) $32 $40 ▢ 5TH ▢ 12TH ▢ 19TH
N1226 ViSalus Go™ Instant Energy 2 oz. Shot – Grape (15 ready-to-drink bottles) $48 $60 ▢ 5TH ▢ 12TH ▢ 19TH
N1070 ViSalus NEURO™ Raspberry Boost Drink Mix (15 Packets) $24 $30 ▢ 5TH ▢ 12TH ▢ 19TH
N1071 ViSalus NEURO™ Lemon Lift Drink Mix (15 Packets) $24 $30 ▢ 5TH ▢ 12TH ▢ 19TH
Side 1 Sub-Total
Form continues on reverse © 2012 ViSalus, Inc. All rights reserved. D1001US-21 1/2

6. 1607 E Big Beaver Rd Suite #110, Troy, MI 48083
Product Order Form Customer Service 1.877.VISALUS
Fax Form To: 877.547.1570
Item No. product description WHOLESALE RETAIL qty total auto-ship
N1077 ViSalus NEURO Raspberry Boost Drink Mix (25 Serving Jar)
™
$38 $48 ▢ 5TH ▢ 12TH ▢ 19TH
N1076 ViSalus NEURO Lemon Lift Drink Mix (25 Serving Jar)
™
$38 $48 ▢ 5TH ▢ 12TH ▢ 19TH
N1221 Anti-Aging & Energy Supplement (30 Capsules per Bottle) $44 $55 ▢ 5TH ▢ 12TH ▢ 19TH
N1222 Supercharged Antioxidant Supplement (30 Tablets per Bottle) $34 $42.50 ▢ 5TH ▢ 12TH ▢ 19TH
N1223 Multi Mineral & Vitamin Supplement (60 Tablets per Bottle) $24 $30 ▢ 5TH ▢ 12TH ▢ 19TH
N1224 Omega Vitals Supplement (60 Softgels per Bottle) $34 $42.50 ▢ 5TH ▢ 12TH ▢ 19TH
N1050 Vimmunity $28 $35 ▢ 5TH ▢ 12TH ▢ 19TH
Side 1
SHIPPING SCALE Check one date for each individual
Total
Order Total Shipping Order Total Shipping Order Total Shipping product you would like Auto-
From To From To From To Date Ordered: / / Shipped to you each month.
$0 $0.99 . . . . . . . . . . $0 $150.01 $300.00. . . . . . . . $14 $2490.00 $4989.99. . . . . . . $50 NOTE: Tax and Shipping & Handling will be added to total.
$0.99 $50.00. . . . . . . . . $6 $300.01 $500.00. . . . . . . . $19 $4990.00 $9989.99. . . . . . . $80
$50.01 $150.00. . . . . . . . $10 $500.01 $2489.99. . . . . . . $25 $9990.00 ∞
. . . . . . . . . . . . $125
ViSalus Auto-Ship Advantage Program
Retail Price: Price for customers who want the product one time. Choose the Auto-Ship Program to guarantee you never run out of product.
Distributor Wholesale Price: Price for distributors and Auto-Ship Advantage Program customers. • Initial orders will be processed and shipped upon receipt.
*Please note: it is against ViSalus policy to sell any ViSalus product below its wholesale price. • Auto-Ship orders will be processed & shipped starting next month on the selected date.
See www.visalus.com for up-to-date product information and additional items. • Auto-Ship orders will be processed on the last business day before a weekend or holiday.
• Changes to Auto-Ship orders must be received at least 5 days prior to Auto-Ship date.
• Customers who select Auto-Ship are “Preferred” and can receive Wholesale pricing.
Customer Shipping Information Customer Billing Information
Last Name:________________________ First Name:_______________________ Full Name on Credit Card:______________________________________________
Shipping Address:___________________________________________________ Billing Address:____________________________________________________
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Fax Order to 1.877.547.1570, call 1.877.VISALUS,
or place order online at www.visalus.com
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