1. gawevrianebis blanki
AGEL Membership Information Form
piradi informacia (Applicant Information)
dro (Time) ------------------------------------ TariRi (Date)
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gvari, saxeli (Name)­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
dabadebis weli (Date Of Birth) ------/------/------
piradobis mowmoba-------------------------------------
telefoni (Phone) mob ------------------------- sax ------------------------- sam -------------------­­­­­­­
faqsi (Fax) ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
el.fosta (E­mail)­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
misamarTi (Mailing
Address)-----------------------------------------------------------------------
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sponsoris informacia (Sponsor / Placement Information)
gvari,saxeli (Sponsor Name)­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
telefoni (Phone) mob ------------------------- sax ------------------------- sam ­­­­­­­­­­­­­­­­­­­­­­­
sponsoris piradi nomeri (Id No.)­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
gawevrianebis meTodi
Retailer
285$ 4 yuTi პროდუქცია ან 1 yuTi kosmetika AGELESS
Monthly Autoship - ყოველთვიური გზავნილი
gadasaxadis TariRi: 1 ricxvi / 5 ricxvi / 10ricxvi
nawarmi romelic minda miviRo pirveli SekveTiT (aRniSneT yuTebis raodenoba)
­­­­OHM/ ­­­­MIN/ ­­­­FIT/ ­­­­EXO/ ­­­­UMI/
­­­­FLX/ ­­­­HRT/
nawarmi romelic minda miviRo meore Tvidan (aRniSneT yuTebis raodenoba)
­­­­OHM/ ­­­­MIN/ ­­­­FIT/ ­­­­EXO/ ­­­­UMI/ ­­­­FLX/ ­­­­HRT/
gadaxdis gza
gadaricxva - rekviziti
SWIFT CODE#: LUMILITXXX
BRANCH: //IL010968
BANK LEUMI
ISRAEL
FOR ACC.#: 544500/83

2. FAVOUR OF: AGEL ISRAEL L.T.D
IBAN CODE:
IL 77 0109 6800 0005 4450 083
(saqonlis miReba angariSis ganaRdebis Semdeg )
gasaRebi(Temp.Password) ---------------------------- arCeuli saxeli (ID No.)
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xelmowera (Signature)----------------------------------------