This product order form from Yoli Inc. allows customers to choose between two initial order packages of either 1,000 CV or 200 CV worth of products. It also provides options to set up automatic monthly replenishment orders. The customer provides payment and shipping information to complete the order.

1. PRODUCT ORDER FORM
: USA Page 1 of 2
Yoli Inc. // P.O Box 808, Sandy, UT 84091 // 1.888.295.9009 // Fax 888.220.7072
Date 08/15/2009
Distributor/Customer Information Amended
Last Name ( please print) First Name Middle Initial Business Name (if different from applicant name) Distributor ID # (if known)
Initial Order Information (Please choose Option A or B)
Wholesale Price Initial Order
Description Item No. (Bulk Discount)
CV Qty Sub-total
Option A (1,000 CV) VIP Builder Pack Bulk Discount Order Package
12 Yoli TRUTH Blast Caps YTC-1002 $ 27.96 500 20 $ 559.20
6 Yoli TRUTH Health Bottles with Caps YTB-1004 $ 19.98 500 28 $ 559.44
Plus Shipping, Handling and Local Tax 1,000 $1,118.64
Option B (200 CV) VIP Order Package Item No. Wholesale Price CV Qty Sub-total
12 Yoli TRUTH Blast Caps YTC-1002 $ 29.99 100 4 $ 119.96
6 Yoli TRUTH Health Bottles with Caps YTB-1004 $ 23.94 100 5 $ 119.70
Plus Shipping, Handling and Local Tax 200 $ 239.66
Autoship Options (Set up your automatic four-week rolling order by choosing the boxes that apply to your order.)
Check One:
Set up an (Auto Ship) order for my account. I understand I will receive my designated order every four weeks after my initial order and that my credit card will be
automatically charged for each order plus applicable shipping and sales tax charges.
I choose not to participate in the Distributor Auto Ship Program at this time Preferred customer only at this time
Choose delivery options:
I want my Auto Ship order delivered each month, regardless of other purchases
I want my Auto Ship order delivered only if I haven't already purchased the minimum amount selected above in any given month
Initial Order
Autoship (200 CV) Will ship the following month Item No. Wholesale Price
CV Qty Sub-total
12 Yoli TRUTH Blast Caps YTC-1002 $ 29.99 100 4 $ 119.96
6 Yoli TRUTH Health Bottles with Caps YTB-1004 $ 23.94 100 5 $ 119.70
Plus Shipping, Handling and Local Tax 200 $ 239.66
Mail the completed signed original Product Order Form to: Yoli Inc // P.O. Box 808, Sandy, UT 84091// Fax 888.220.7072 V1.0 ©2009

2. PRODUCT ORDER FORM
Page 2 of 2
: USA Yoli Inc. // P.O Box 808, Sandy, UT 84091 // 1.888.295.9009 // Fax 888.220.7072
Initial Order and Auto Ship Payment
Payment : (check one) Visa Master Card American Express Discover
Credit card # Expiration date (mm/yyyy)
Credit card billing address city, state, zip
Name (as shown on card) CVV Code Signature of card holder Date(mm/dd/yyyy)
X
Commissions : (Please fill in your account information for commissions direct deposit)
Name(s) on account Account #
Bank name Bank routing #
Bank address (optional)
Please attach voided check to this form (check must be preprinted with your name)
Signature on account
X
Mailing Information Shipping Information
Mailing name Shipping name ( if different than mailing)
Address Address
City State Zip Code Country City State Zip code Country
Signature Date (mm/dd/yyyy)
X 08/15/2009
E-mail address Phone number
NOTICE OF RIGHT TO CANCEL
You may CANCEL this transaction, without any penalty or obligation, within THREE BUSINESS DAYS from the date of
your order (5 business days for AK residents). If you cancel, any property traded in, any payments made by you under the
contract or sale, and any negotiable instrument executed by you will be returned within TEN BUSINESS DAYS following receipt
by the seller of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel,
you must make available to the seller at your residence, in substantially as good condition as when received, any goods
delivered to you under this contract or sale, or you may, if you wish, comply with the instructions of the seller regarding the
return shipment of the goods at the seller’s expense and risk. If you do make the goods available to the seller, and the seller
does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods
without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the
seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this
transaction, mail or deliver a signed and dated copy of this Cancellation Notice or any other written notice, or send a telegram
to Yoli Inc., P.O. Box 808, Sandy, UT 84091 NOT LATER THAN MIDNIGHT of the third business day following the date of sale.
Buyer’s Signature ____________________________________ Date __/___/____
(I HEREBY CANCEL THIS TRANSACTION)
Mail the completed signed original Product Order Form to: Yoli Inc. // P.O. Box 808, Sandy, UT 84091// Fax 888.220.7072 V1.0 ©2009