USANA

PREFERRED CUSTOMER ORDER FORM

Associate ID#: 296618

SHIPPING INFORMATION                                                                     Language Preference English French Spanish Chinese-Catonese Chinese-Mandarin Japanese German Dutch
First Name    Last Name   Email
       Street     City 
        State  Select State AK AL AR AZ CA CT DC DE GA HI ID IA IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VI VT WA WI WV WY     Zip Code    County      USA
Day Phone   Evening Phone   Fax   

Payment Method VISA Master Card American Express Discover Bank Check Money Order Personal Check   Card #   Expires (Month) 1 2 3 4 5 6 7 8 9 10 11 12 (Year) 2004 2005 2006 2007 2008 2009 2010

Card Holder's Name   Card Holder's Signature                                                      
Credit Card Statement Address (if different from shipping address):    Street
                                 City State: Select State AK AL AR AZ CA CT DC DE GA HI ID IA IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Code   

SAVE an additional 10% by enrolling in AUTOSHIP. Monthly supplies will be delivered automatically. You can customize or cancel your shipments at any time. Yes, No, do not enroll me in AUTOSHIP to save an additional 10%.

* SHIPPING AND HANDLING
Your shipping cost will be USANA's actual freight cost plus a USD $1.00 handling fee. Your shipping charge will be an estimate made at the time of your order. The estimate is a computer generated charge and is calculated using the weight of the product and the fill material.

FAX this order to: 1-800-289-8081 or MAIL to:  USANA DATA PROCESSING or Call Order Express: 1-888-950-9595
                                                                                        BOX 4000
                                                                                        TOOELE, UT  84074

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