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Direct Dep Authorization Form 0503
Direct Dep Authorization Form 0503
DATE: (Month/Day/Year) TO: HERBALIFE INTERNATIONAL PHILIPPINES, INC. FAX NO. (632) 899 5005
request HERBALIFE INTERNATIONAL PHILIPPINES, Inc. to process the following order(s) paid for by the bank deposit I transacted with ( Name of Bank/Branch ) for the total amount of P
TOTAL AMOUNT
ORDER NUMBER
Complete order forms and copy of the deposit slip are attached.
SIGNATURE :