Distribution: W hite for your records, Pink to Customer
Copyright © Herbalife Nutrition. All right reserved 5001-IN-05
Independent Associate
Order Date: ____________________
RETAIL ORDER FORM
Herbalife Nutrition Independent Associate (Seller)
Associate Name: _________________________________________________________________________________
Associate ID No.: ________________________________________________________________________________
Address: _______________________________________________________________________________________
Address: _______________________________________________________________________________________
City: ____________________________________________ State: _________________________________________
Pin Code: _______________________________________ Telephone/Mobile No.: ____________________________
GST registration number: ___________________________
Email: __________________________________________
CUSTOMER (Buyer)
Name: _________________________________________________________________________________________
Address: _______________________________________________________________________________________
Address: _______________________________________________________________________________________
City: ____________________________________________ State: _________________________________________
Pin Code: _______________________________________ Telephone/Mobile No.: ____________________________
GST registration number: ___________________________
Email: __________________________________________
Quantity
Product Description
*
Price per unit
Total
The products will be:
Payment method type:
□ Cash
□ Card
□ Other (e.g. UPI,
Instalments, etc.,) **
_______________________
_______________________
_______________________
Freight / Postage
(if applicable)
□ delivered by post/courier □ directly delivered by seller
Tax at __ % ***
[IGST/CGST-SGST]
□ collected from your Herbalife Nutrition Independent Associate at:
_____________________________________________________
Time & Place for product sampling: ________________________
_____________________________________________________
TOTAL
Payment with order directly to the Seller.
Your contract of sale is with your
Herbalife Nutrition Independent Associate
who is an independent seller of Herbalife
Nutrition products and is not an agent of
Herbalife Nutrition.
* Country of origin of goods – India
** Independent Associate to specify payment terms.
***Associates are required to raise a tax invoice under the GST law, if applicable
Seller identity proof was shown for verification - Yes No
Date & Place: ____________________ ___________________________________
Customer’s Signature / Thumb impression
Distribution: W hite for your records, Pink to Customer
Copyright © Herbalife Nutrition. All right reserved 5001-IN-05
HERBALIFE NUTRITION REFUND POLICY
Herbalife Nutrition (Herbalife International India Pvt. Ltd., RMZ Pinnacle, No. 15, Commissariat Road, Bangalore – 560
025) offers an exchange or a full refund. Simply request a full refund of the purchase price or a full credit note towards the
purchase of another Herbalife Nutrition product or products from your Herbalife Nutrition Independent Associate within 30
days from your receipt of the product, return the unused portion of the product along with the copy of the Retail Order Form
– Receipt to the Herbalife Nutrition Independent Associate named on the top of this form.
LEGAL RIGHT OF CANCELLATION
In case of a delay in product delivery from the timeline offered during the sale, Herbalife Nutrition Independent Associate
has to honor the customer’s request for order cancellation and refund the payment made by the customer as per agreed
terms during the sale.
TOTAL SATISFACTION
Herbalife Nutrition is sure you will have total satisfaction from your purchase. However, if any reason, you are not totally
satisfied, contact your Herbalife Nutrition Independent Associate.
If still not satisfied, contact Herbalife International India Pvt. Ltd., RMZ Pinnacle, No. 15, Commissariat Road, Bangalore –
560 025, Karnataka, India, Phone: +91 80 40311444.
Any consumer who is still not satisfied may write to us at wr[email protected].
FREE DEMONSTRATION
PLEASE ARRANGE TO GIVE A FREE HOME DELIVERY
Name: _________________________________________________________________________________________
Address: _______________________________________________________________________________________
Address: _______________________________________________________________________________________
City: ____________________________________________ State: _________________________________________
Pin Code: _______________________________________ Telephone: _____________________________________
Name: _________________________________________________________________________________________
Address: _______________________________________________________________________________________
Address: _______________________________________________________________________________________
City: ____________________________________________ State: _________________________________________
Pin Code: _______________________________________ Telephone: _____________________________________
I UNDERSTAND THAT THIS ORDER MAY BE CONSIDERED AS AN INVITATION TO CALL UPON ME FROM TIME
TO TIME, WITH THE UNDERSTANDING THAT I WILL UNDER NO OBLIGATION TO BUY.
PRIVACY NOTICE
By signing this form, I consent that you, the associate, may collect and process my personal data, including sensitive
personal data, provided by me in this form in accordance with applicable data protection laws and as set forth in the
associate’s privacy policy, which I have read and understood, and which forms an integral part hereof. I consent to the
sharing of my personal data in this form with Herbalife Nutrition. This personal data should not be used for any purposes
other than to process my order, meet legal or contractual obligations, develop the business relationship between me and
the associate, and to allow the associate to contact me with recommended programs and products. I understand that my
personal data may be retained for as long as necessary to fulfill these purposes. I understand that I may at any time
withdraw my consent by a written request to the associate that collected my data. I understand that I have the right to
access, to update and make corrections to my personal data. I may contact the associate directly to make such a request.
I understand that Herbalife Nutrition shall not be liable in any manner whatsoever for any breach of data protection vis a
vis my personal data collected by the associate.
Date & Place: ____________________ ___________________________________
Customer’s Signature / Thumb impression