Step 1 Place Your Order

RM 120 Membership Fee (Required)

• Allows you to purchase XanGo™ at Wholesale
• Awards you a Xango™ ID so that you can start sharing XanGo™ with others (Optional)
• Includes Distributor Kit w/ Online Back Office, Corporate Literature & 2 Powerful DVD's

Please choose an initial order of 1,2, or 5 cases:

1 Case Order (4 bottles) = RM 465

• Earn 30% Power Start bonus paid Weekly!
• Get Paid Up to 5 Times per month
• Earn on up to 5 levels of Dynamic Compression in the XanGo™ Compensation Plan

2 Case Order (8 bottles) = RM 930

• Earn 45% Power Start bonus Paid Weekly
• Get Paid Up to 5 Times per Month
• Earn on up to 9 levels of Dynamic Compression in the XanGo™ Compensation Plan
• Qualify for Revenue Sharing Bonus Pool

5 Case Order (20 bottles) = RM 2,325 * Recommended *

• Earn 45% Power Start bonus Paid Weekly
• Get Paid Up to 5 Times per Month
• Earn on up to 9 levels of Dynamic Compression in the XanGo™ Compensation Plan
• Qualify for Revenue Sharing Bonus Pool
• Reach 5K with just nine others who duplicate 5 Case Orders

Receive FREE tools and Membership with this order.

Important Note: XanGo™ has a convenient Auto Delivery Program that you will automatically be placed on. Initial orders of 1 case will go on 1 case autoship. 2 and 5 case initial orders will be placed on 2 case autoship.

Please fill out this form, so that you receive your XanGo ID already today. Your host will contact you with all dates, passwords and required information.

We recommend to pay by credit card (Mastercard or Visacard), so that you already receive your starterkit and the first boxes of XanGo in a few days.

If you like to pay via bank transfer, you will receive all necessary banking information and a reference number.

Even if you pay by credit card - indicate your own banking information, so that XanGo can transfer the commissions directly to you.

Personal Information
Form of address	:	Mr Mrs
First Name	:
Last Name	:
Date Of Birth	:	DD01020304050607080910111213141516171819202122232425262728293031 . MM010203040506070809101112 . YYYY190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010
Street	:
Zip Code/City	:
State	:
Country	:	Australia Austria Belgium Bermuda Canada Denmark Finland France Germany Hong Kong Hungary Indonesia Ireland Italy Japan Liechtenstein Luxembourg Malaysia Mexico Monaco Netherlands New Zealand Norway Philippines Portugal Singapore Spain Sweden Switzerland Taiwan Trinidad and Tobago United Kingdom United States
Cellphone	:
E-mail	:	You will receive your access code in this email account.
Identity Card No.	:
Sponsor Information
Sponsor XanGo ID	:
Sponsor Name	:
Bank account for commission payment
Bank Name	:
Account Holder	:
Account No.	:
Your first order
First order	:	2 cases XanGo + Starter Kit - RM 1,050 1 case XanGo + Starter Kit - RM 585 1 case XanGo (No Starter Kit) - RM 465 5 cases XanGo + Starter Kit - RM 2,445 No initial order
		Purchase 2 boxes of juice get 1 box f.r.e.e, you pay RM 930 get RM 1,395 value
ADP for the following month	:	2 cases XanGo (Power Start Double Depth) - RM 930 1 case XanGo (Power Start Plus) - RM 465 No ADP at this time
Decide on 1 case and ADP 1 and receive 30 % to Fast Start bonus Decide on 2 cases and ADP 2 and receive 30% + 15% to Fast Start bonus
Pay your order by credit card
Cardholder Name	:
Type of Card	:	Visa Mastercard
Card Number	:
Expiration Date	:	MM 01 02 03 04 05 06 07 08 09 10 11 12  /  YYYY 2009 2010 2011 2012 2013 2013 2013 2013
Card Verification Number	:	(On the back of your card, find the last 3 digits)
Note : Your credit card information is not stored for security purposes