Herbalife Products Malaysia Sdn Bhd Ground Floor, Plaza See Hoy Chan Jalan Raja Chulan, 50200

Kuala Lumpur Tel: (603) 2687 6333 Fax: (603) 2687 6222 Dear Valued Distributors, If you wish to charge your Herbalife purchases with your credit card via phone, fax and email, please fill in the Credit Card Authorization portion and return to our Distributor Services Department for processing. You are allowed to register and utilize up to THREE (3) credit cards (Visa/Master only) for your purchases from Herbalife Products Malaysia Sdn Bhd. Later, if you decide to use a different credit card other than those stated as below, kindly submit a separated authorization form/letter to our Distributor Services Department for verification and update. Note : i) Please attached a photocopy of your credit cards (both side) ii) Distributors are not allowed to use third party credit cards to purchase products or make payment for third party

Credit Card Authorization

Credit Card Holders Information:
Name (as in NRIC): ________________________________________________ NRIC No (New) : ________________________________________________ ID Number Tel : ___________________________________ : ___________________________________

Card Holders Name

1) 2) 3)

Credit Card No

CVC

Issuing Bank

Expiry Date

I hereby authorize Herbalife Products Malaysia Sdn Bhd to CHARGE my credit card account (s) for purchases made via phone in, email, fax in and mail in under my ID (Independent Distributor) Number.

_____________________________________ Signature of Card Holder

_________________________________ Date

Cancellation of Credit Card: (Kindly fill up the credit card details for cards you wish to cancel)
Card Holders Name
1) 2) 3)

Credit Card No

Issuing Bank

I hereby authorize Herbalife Products Malaysia Sdn Bhd to withdraw and cease using my credit card account with immediate effect.

_____________________________________ Signature of Card Holder

_________________________________ Date

Terms & Conditions for Credit Card Authorization: 1. Herbalife Products Malaysia Sdn Bhd is under no obligation to honour any credit card debt instruction unless there is sufficient available credit limit in the Credit Card account at the time of effecting payment. 2. Herbalife Products Malaysia Sdn Bhd shall not be responsible for any claim on loss, damage, costs and expenses arising from the unsuccessful processing of the orders or remittance for any reason whatsoever, including but not limited to malfunction of system, electricity failure, inaccurate or insufficient information being supplied by the applicant. Herbalife Products Malaysia Sdn Bhd reserves the right to change the Terms and Conditions and determine the arrangements for the service provided hereunder at its discretion without assigning any reasons. The applicant agrees that Herbalife Products Malaysia Sdn Bhd shall be entitled to impose charges as deemed appropriate for providing the service mentioned hereunder with prior notice to the applicant. Herbalife Products Malaysia Sdn Bhd may at any time and from time to time without prior notice withdraw from providing the service mentioned hereunder at any time without assigning any reasons therefore and shall not be held liable for any loss or damage which any be suffered by the applicant as a result of such action by Herbalife. The authorization remains in force unless revoke by applicant in writing.

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