Amway India Enterprises Pvt. Ltd.

Regd Office : First Floor, Elegance Tower, Plot No. 8,

Non Hierarchical Commercial Centre, Jasola, New Delhi - 110 025.
DISTRIBUTOR NUMBER :

DISTRIBUTOR ORDER FORM

PICK UP

Updated On 22-02-12

HOME DELIVERY

Location :

DISTRIBUTOR NAME :

For Office Use only :

Whether the ABO Name on the Order Form and the system is same YES
SKU Nos. Qty

Description

PV

DAP*

248392

Numberless Application Pad - 20

----

100.00

241553

Olive Pomace Oil

1.21

364.00

247970
9640
248390

0.00
0.00
0.00

2.00
2.00
25.00

107766
100141
100142
102578
5985
100309
8086
100260
102745
100997
101153
101154
109960
101419
89
100066
212132
100076
242462
242464
217040
100070
105074
102992
242259
8617
242461
8669
100346
4302
8600
100352

Amway Polybags
Positirm Polybags
Customer Receipt Pad
NUTRITION & WELLNESS
Nutrilite Protein Powder 1 Kg.
Nutrilite Protein Powder 500 gms
Nutrilite Protein Powder 200 gms
Nutrilite Protein with Green Tea 500gms
Siberian Ginseng 100 Tabs
Triple Guard Echinacea 60 Tabs
Glucosamine HCL 120 Tabs
Nutrilite Daily 60 Tabs
Nutrilite Daliy 120 Tabs LM
Nutrilite Iron Folic 90 Tabs
Nutrilite BIO C 100 Tabs
Nutrilite Parselenium E 30 Tabs
Nutrilite Cal Mag D 90 Tabs
Nutrilite Natural B 100 Tabs
Nut. Bone Health with IPR-60 Tabs
Salmon Omega 3 - 60 Tabs
Positrim Chocolate Low Fat Drink Mix-15
Nutrilite Garlic Heart Care-60 Tabs
Kids Chocolate Drink - 500 gms
Kids Mango Drink - 500 gms
Positrim Vanilla Low Fat Drink Mix (15)
Nutrilite CH Balance - 60 Soft Gels
Nutrilite Fibre 200 gms
Nutrilite Conc. Fruit & Veg 60 Tab
Kids Drink Mixed Fruit - 500 gms
Kids Chewable Vitamin C-100 Tabs
Kids Chewable Multivitamin-60Tabs
Kids Chewable Iron - 100 Tabs
Kids Chewable Conc.Fruit-Veg - 60
Nut Kids Chewable Cal.Mag - 100
Nutrilite Glucose Health
Nutrilite Milk Thistle

34.70
20.59
9.79
22.83
30.70
16.68
30.69
13.67
23.12
8.67
13.12
12.67
6.89
8.56
25.80
13.90
21.12
7.56
10.77
10.77
20.58
29.80
9.89
17.68
10.77
16.68
13.12
7.23
16.68
8.89
16.68
17.79

2599.00
1543.00
733.00
1710.00
2299.00
1250.00
2299.00
1024.00
1733.00
649.00
983.00
949.00
516.00
641.00
1933.00
1041.00
1583.00
566.00
808.00
808.00
1541.00
2233.00
741.00
1324.00
808.00
1249.00
983.00
541.00
1249.00
665.00
1249.00
1333.00

8156
8392
137
228
8391
138
8393
3941
33
101158
4110
4111
8095
8945
100949
3417
8967
7506

HOME CARE
L.O.C. High Suds 1 ltr
L.O.C. High Suds 500 ml
L.O.C. Sachet 8 ml
Dish Drop 1 ltr
Dish Drop 500 ml
Dish Drop Sachet 8 ml
Zoom 500 ml
See Spray 500 ml
S A 8 Gelzyme 1 ltr
S A 8 Gelzyme 500 ml
S A 8 Delicate 500 ml
Carwash 500ml
Leather & Vinyl Cleaner 500 ml
S A 8 Pre Wash Liquid 500 ml
APSA - 80 500 ml
APSA 80 1 ltr.
Silicone Glaze 500 ml
Pursue Disinfectant 500 ml

4.73
2.86
0.06
6.22
3.64
0.06
2.79
2.79
7.95
4.68
4.32
2.73
3.29
4.44
5.11
8.35
5.44
2.85

354.00
214.00
5.00
467.00
272.00
5.00
209.00
209.00
596.00
351.00
324.00
204.00
246.00
332.00
383.00
625.00
408.00
213.00

215434
215435
215436
2183
100661
6826

PERSONAL CARE
Sat.Adv.2in1Shamp&Cond.Sach-20
Sat.Adv.DandfCntrlShampSach-20
Sat.Adv. Moist. Detangler Sach-20
G & H Lotion 250 ml
G & H Lotion 60 ml
G & H Body Shampoo 250 ml

1.20
1.20
1.20
4.39
1.39
4.39

100.00
100.00
100.00
329.00
104.00
329.00

Total
Value

1.

In case of TNA, would you like Amway to place alternate order for you of the same PVs Yes

2.

The above prices are subject to change. Please check the actual price before placing the order.

PAYMENT MODE : CASH

CR.CARD

DD

A/R

Turn around for the New Payment Modes

available for ordering

NO
SKU Nos. Qty

TM

DATE :

SIGN (CASHIER)
Description

100660
246220
215358
216916
241041
246173
2184
200760
100950
212738
212739
212740
5070
5030
5050
5060
230396
230414

G & H Body Shampoo 60 ml

Advance SR.Toothbrush(Pack of 4)
Persona Talcum Powder - 350 gms
Persona Talcum Powder - 200 gms
Advance JR.Toothbrush(Pack of 4)
Persona Bar Soap 3 pcs.
Nature Show Crme Hand Soap 250 ml
Glister Multi - Action TP 100 g
Sweet Shot Mint
Dynamite Shaving Foam
Dynamite After Shave Moisturiser
Dynamite After Shave Splash
Sat. Hair Rejuvenating Masque
Satinique Adv. 2 in 1 Sh. & Cond.
Satinique Adv. Moist. Detang & Cond.
Satinique Adv. Dandruf Contl Shmp.
Attitude Deodrant for Women 150ml
Dynamite Deodrant for Men 150ml

107992
100183
100240
101821
101822
101823
101824
104020
104126
104127
104128
104129
104130
104131
105531
106399
106401
234060
233886
233889
239111
239113
239112
233892
234073
234246
234248
234249
234250
234293
234294
234193
234209
234210
234214
234215
234245
241701
241702
244654
244655
244656
244657
244658
244659
244660
244661
266662

COSMETICS
Alpha Hydroxy Serum Plus
Aritistry Creamy Massage
Skin Refinishing Lotion
Time Defiance Day Cream
Time Defiance Day Lotion
Time Defiance Night Time Cream
Time Defiance Night Time Lotion
Pure Whitening Essence - New
Ess Hydrating Cleanser - Dry
Ess Hydrating Toner - Dry
Ess Hydrating Lotion - Dry
Ess Balancing Cleanser - Oily
Ess Balancing Toner - Oily
Ess Balancing Lotion - Oily
Replenishing Eye Cream
Polishing Scrub
Moisture Intense Masque
Lipstick Natural Pink
Attitude Eye Pencil - Met Silver
Attitude Eye Pencil - Kajal Coal
Attitude Eye Pencil - Cobalt Blue
Attitude Eye Pencil - Dark Brown
Attitude Eye Pencil - Deep Purple
Lip Pencil - Gorgeous Red
Mascara
Attitude Face Wash
Attitude Sun Screen
Attitude Face Masque
Attitude Hand & Body Creame
Attitude Foot Creame
Eye Liner
Attitude Cleanser Oily
Attitude Toner Oily
Attitude Moisturiser Oily
Attitude Cleanser Dry
Attitude Toner Dry
Attitude Moisturiser Dry
Attitude Eyeshadow Luminous Touch
Attitude Blushers Natural Haze
Attitude Lipstick Choco Temptation
Attitude Lipstick Marron Magic
Attitude Lipstick Natural Brown
Attitude Lipstick Brown Dazzle
Attitude Lipstick Sassy Pink
Attitude Lipstick Plum Shine
Attitude Nailenamel-Crimsonstorm
Attitude Nailenamel - PinkSlush
Attitude Nailenamel - Honey Glaze

PV

DAP*

1.39
1.47
2.10
1.42
1.03
1.44
4.39
1.44
2.21
3.21
1.85
3.88
4.85
4.39
4.39
4.39
2.55
2.55

104.00
110.00
158.00
107.00
77.00
108.00
329.00
108.00
166.00
241.00
138.00
291.00
363.00
329.00
329.00
329.00
191.00
191.00

25.58
17.68
25.58
25.68
25.68
25.02
25.68
23.35
12.79
12.79
15.00
12.79
12.79
15.00
8.33
12.79
12.79
2.67
2.79
3.12
3.12
3.12
3.12
2.52
3.89
2.77
4.11
3.32
3.32
3.17
4.39
3.77
3.77
6.18
3.77
3.77
6.18
5.00
5.00
2.88
2.88
2.88
2.88
2.88
2.88
1.50
1.50
1.50

1916.00
1324.00
1916.00
1924.00
1924.00
1874.00
1924.00
1749.00
958.00
958.00
1124.00
958.00
958.00
1124.00
624.00
958.00
958.00
199.00
208.00
233.00
233.00
233.00
233.00
188.00
292.00
208.00
308.00
249.00
249.00
238.00
329.00
283.00
283.00
463.00
283.00
283.00
463.00
375.00
375.00
216.00
216.00
216.00
216.00
216.00
216.00
113.00
113.00
113.00

Total
Value

No
(Please put the ship to Address on the reverse side of the order form)

Distributors Signature
BONUS CHEQUE
ITZ CARD
Please fill in this form all relevant information before you approach the cashier
Please present you Amway ID card or Copy of SA 88 ID (Application Form)
Trademarks of Amway Corp. Ada. MI U.S.A. All rights revesered. Printed in India.)
P.T.O.

TEAR OFF
Receipt (To be filled in by Cashier)
ORDER NO.

DATE

CASH

CCARD

DD

BC

AR

PC

ITZ

TOTAL AMOUNT

Cashiers Signature

SKU Nos. Qty

Description

PV

DAP*

244663
244664
106136
106147
106150

Attitude Nailenamel - Nutty Brown

Attitude Tester Pack
Hydrating Foundation-Cameo (Fair)
Hydrating Foundation-Soleil (Medium)
HydratingFoundation-Golden(MedtoFair)

1.50
0.00
22.24
22.24
22.24

113.00
119.00
1666.00
1666.00
1666.00

230295
231244
246174
230415
231227
212737

GREAT VALUE PRODUCTS

Persona Classic Toothbrush (Pk 4)
Dynamite Razors (Pack of 10)
Persona 100% Pure Coconut Oil
Persona AMLA Hair Oil 200 ml
Dynamite Hair Cream 150 g Tube
Dynamite Shaving Cream 70 g (2)

0.92
1.47
0.73
0.42
0.52
0.56

68.00
147.00
109.00
64.00
77.00
82.00

868
1605
9061
204239
1065
1075
1404
9137
9198

SALES AID
Personal Care Pump Disp.
Home Care Pump Disp. 1 ltr
Home Care Pump Disp. 500 ml
Pour & Measure Cap
Pistol Grip Sprayer
Squeeze Bottle
Turret Top Cap
Body Sponge (Ivory)
Body Sponge (Peach)

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

21.00
46.00
46.00
45.00
27.00
18.00
9.00
38.00
38.00

Total
Value

Introducing New Payment

Mode !!!!

AMWAY CASH CARD

Collect your Card Today !

No Subscription Fee / No Renewal Fee

One Time Activation Charge
of Rs. 10/- only + Service Tax
So .... STOP Carrying Cash
STOP Writing Currency
Series on the Order Form.

PAY BY CHALLAN (PBC)

Only 2 Simple Steps to be followed

DENOMINA
TION
DENOMINATION
1000
500
100
50
20
10
5
COINS

x
x
x
x
x
x
x
x

1.

Place your order at Amway Call Centre on

080 - 3941 6600
Request for PBC Option

2.

Deposit Cash within 2 working days at any of

the Axis Bank Branch and get Amway
Products delivered at your door step or to
Ship to Address .
For Further Details
Please Contact the Customer Service Desk

Total Amount
Distributor No. .......................................................

PLEASE TICK :

YOUR PARTICULARS : SHIP - TO ADDRESS

CONTRIBUTION TO AOF Re. 1/- YES

NO

PLEASE TICK IF DIFFERENT FROM ADDRESS ON FILE (Not available when paying by credit card)

(Only for Home Delivery orders)

*Distributor First Name (Distributor Names, if applicable, as specified on file)

(Surname or name of Indian proprietorship concern or Indian partnership)

*Ship-To-Address

Locality

State

PIN Code

Name of Post Office

OR

*Land mark (Please specify a landmark near your address for ease of delivery)

*Telephone (Residence)

*Telephone (Office)

STD CODE

PHONE NO.

STD CODE

Mobile

PHONE NO.

* Fields are mandatory.

IF YOUR PAYING BY CASH AND OF RS. 500/- OR RS. 1000/- DENOMINATION PLEASE FILL THE BELOW PART
NOS. OF NOTES :1 ________________ 5 ________________ 9 _________________ 13 ________________ 17 _______________

21 _______________

2 ________________

6 ________________

10 ________________ 14 ________________

18 _______________

22 _______________

3 ________________

7 ________________

11 ________________ 15 ________________

19 _______________

23 _______________

4 ________________

8 ________________

12 ________________ 16 ________________

20 _______________

24 _______________