SAMPLE FORMS

Introduction
The following pages contain samples of forms which you may be required to use to communicate with
Herbalife as you conduct your business. They are included to help you become familiar with them and to
assist you in completing them. Please review them and become familiar with their use.

Table of Contents

Herbalife Advantage Program – Personal Consumption Herbalife

Advantage Program – Resale
Retail Order Form
Automatic Payment Service (APS) Business Authorization Agreement
Change of Address Form
Customer Request for Refund Form
Earnings Certification Form Royalty Override/Production Bonus and 10 Retail Customers/70% Rule
Documentation
Repurchase of Inventory
Inventory Repurchase Request Form
Products Return Form
Literature and Sales Aids Return Form
Bank Information Form
Change of Bank Information Form
Nutrition Club Operator’s Advisory
Hygiene and Sanitary Practices Advisory for Nutrition Club Operators
Healthy Weight Challenge Participation Agreement

Rev. 05/19/23
 PERSONAL CONSUMPTION
CANADA
HERBALIFE ADVANTAGE PROGRAM
Phone Orders - (866) 622-1222
Herbalife of Canada, Ltd.
7075 Place Robert Joncas, Suite 113 Date:
Saint-Laurent, Quebec H4M 2Z2
Yes, please activate my Herbalife Advantage Program
Hours of operation:
Walk in orders: Monday - Friday 8:30 a.m. - 5:00 p.m. (Eastern Time) New Activation
Saturday 10:00 a.m. - 14:00 p.m. (Eastern Time) Amend Order
Phone orders: Monday - Friday 7:00 a.m. - 6:00 p.m. (Pacific Time)
Saturday 7:00 a.m. - 2:00 p.m. (Pacific Time)
Purchase By 1 Ship To 2
Name
Name
Address

ID No.
Fully Qualified Supervisor 3
Telephone Fax
Name Payment Method 4
Your automatic HAP order will be billed each month and
ID No. will be shipped withing 3 days after payment is processed.
Since your HAP order is an automatic monthly shipment
Month & Year of Qualification / program, you must select the credit card options below for
Month Year Herbalife to process your order.

Visa MasterCard American Express

Automatic Monthly Order (minimum 100 Volume Points) APS PIN Code

*See Price List to determine Volume Points, Retail and Credit Card #
Wholesale prices. Expiry Date: Month/Year /
Authorized Signature:
Discount % A B C
Total Volume Total Wholesale
Stock No. Product Name Qty Total Full Retail
Points Price

Totals A B
Wholesale Total C
Please Complete for this Order 5 Non-Taxable Wholesale Total D
Volume Points for this order Volume Points for previous Taxable
orders Sub Total (C-D)
Total Volume
E Points
For the month of
Shipping and Handling (4.75% - $11.00 minimum) OR
F
Pick Up and Handling (5.25% - No minimum)
Tax (GST, HST, PST, QST where applicable)
G
Tax % x Total of E + F
Pick Up and Shipping Option 6
Pick Up & Handling Shipping & Handling Total Amount Due
(5.25% - No minimum) (4.75% - $11.00 minimum) (Add C + F + G)
©2018 Herbalife International of America, Inc. All rights reserved.

Rev. 05/19/23
 RESALE
CANADA

Herbalife of Canada, Ltd.

HERBALIFE ADVANTAGE PROGRAM
Phone Orders - (866) 622-1222
7075 Place Robert Joncas, Suite 113 Date:
Saint-Laurent, Quebec H4M 2Z2
Yes, please activate my Herbalife Advantage Program
Hours of operation:
Walk in orders: Monday - Friday 8:30 a.m. - 5:00 p.m. (Mountain Time) New Activation
Saturday 9:00 a.m. - 12:00 p.m. (Mountain Time) Amend Order
Phone orders: Monday - Friday 7:00 a.m. - 6:00 p.m. (Pacific Time)
Saturday 7:00 a.m. - 2:00 p.m. (Pacific Time)
Purchase By 1 Ship To 2
Name
Name
Address

ID No.
Fully Qualified Supervisor 3
Telephone Fax
Name Payment Method 4
Your automatic HAP order will be billed each month and
ID No. will be shipped withing 3 days after payment is processed.
Since your HAP order is an automatic monthly shipment
Month & Year of Qualification / program, you must select the credit card options below for
Month Year Herbalife to process your order.

Visa MasterCard American Express

Automatic Monthly Order (minimum 100 Volume Points) APS PIN Code

*See Price List to determine Volume Points, Retail and Credit Card #
Wholesale prices. Expiry Date: Month/Year /
Authorized Signature:
Discount % A B C
Total Volume Total Wholesale
Stock No. Product Name Qty Total Full Retail
Points Price

Totals A B
Wholesale Total C
Please Complete for this Order 5
Retail Total B
Volume Points for this order Volume Points for previous orders Wholesale Total
Non-Taxable Total Volume
D Points
For the month of Taxable Sub Total (B-D) E
Tax (GST, HST, PST, QST where applicable)
F
Tax % x E
Shipping and Handling (4.75% - $11.00 minimum) OR
G
Pick Up and Shipping Option 6 Pick Up and Handling (5.25% - No minimum)
Pick Up & Handling Shipping & Handling Total Amount Due
(5.25% - No minimum) (4.75% - $11.00 minimum)
(Add C + F + G)
©2018 Herbalife International of America, Inc. All rights reserved.

Rev. 05/19/23
 RETAIL ORDER FORM/
FORMULAIRE DE COMMANDE AU DÉTAIL
FOR USE IN ALL CANADIAN PROVINCES AND TERRITORIES (EXCEPT QUÉBEC)
Herbalife of Canada LTD POUR UTILISATION DANS TOUTES LES PROVINCES CANADIENNES (A L’EXCEPTION DU QUÉBEC
113-7075 Place Robert-Joncas
St-Laurent, Québec H4M 2Z2
Telephone 866-622-1211 Fax : 514-336-4846
30-DAY MONEY-BACK GUARANTEE/ DATE OF SALE/
GARANTIE DE REMBOURSEMENT DE 30 JOURS DATE DE LA VENTE
MONTH/MOIS DAY/JOUR YEAR/ANNÉE

CUSTOMER/CLIENT

ADDRESS/ADRESSE

CITY/VILLE PROVINCE PHONE/TÉLÉPHONE ( )

EMAIL (Courriel) FAX

QUANTITY/QUANTITE DESCRIPTION/DESCRIPTION STOCK#/NO PRICE/PRIX

Terms of Payment cash check Visa MasterCard AMEX/ SUBTOTAL/

Mode de paiement argent comptant chèque Visa MasterCard AMEX SOUS-TOTAL
Delivery Date/Date de livraison PROV. TAX/
TAXE PROV.
Comments/Commentaires FREIGHT/
TRANSPORT
G.S.T. (TPS)/
H.S.T. (TVH)
TOTAL/TOTAL

By signing this form, I give consent to my Herbalife Independent Distributor (“Distributor”) to use my information for purposes of
processing my order and providing me with customer service. I further consent to the sharing of my information with Herbalife of
Canada LTD (“Herbalife”) so that they may facilitate my order, validate sales and fulfill compliance obligations. Herbalife or
its authorized third parties may contact me directly for these purposes. I understand that Herbalife may in turn share my
data with its affiliates, third party service providers, and other persons identified in Herbalife’s privacy policy at
https://www.herbalife.ca/privacy-policy, including persons located in countries outside of Canada (such as the United States
and Mexico) that may not offer the same level of data protection as my own country. For more details, I understand that I may view
Herbalife’s privacy policy at https://www.herbalife.ca/ privacy-policy, or contact Herbalife at +1 866-622-1211 or
privacy@herbalife.com.

En signant ce formulaire, j'autorise mon distributeur indépendant Herbalife (« le distributeur ») à utiliser mes informations aux fins
de traiter ma commande et de me fournir un service client. Je consens en outre au partage de mes informations avec Herbalife of
Canada LTD (« Herbalife ») afin qu'ils puissent faciliter ma commande, valider les ventes et respecter les obligations de conformité.
Herbalife ou ses tiers autorisés peuvent me contacter directement à ces fins. Je comprends qu'Herbalife peut à son tour partager
mes données avec ses affiliés, des tiers fournisseurs de services et d'autres personnes identifiées dans la politique de
confidentialité d'Herbalife à https://www.herbalife.cafr/privacy-policy, y compris des personnes qui résident dans des pays hors
du Canada (comme les États-Unis et le Mexique) et qui n'offrent pas forcément le même niveau de protection des données
que mon propre pays. Pour plus de détails, je comprends que je peux consulter la politique de confidentialité d'Herbalife à
https://www.herbalife.cafr/privacy-policy, contacter Herbalife au 866-622-1211 ou consulter privacy@herbalife.com.

SEE OVERLEAF FOR STATEMENT OF CANCELLATION RIGHTS/BUYER’S RIGHTS TO CANCEL.

VOIR AU VERSO POUR LA DÉCLARATION DES DROITS DE RÉSILIATION/DROITS D’ANNULATION DE L’ACHETEUR.

All taxes calculated on customer’s address / Toutes les taxes ont été calculées à partir de l’adresse du client
2021 Herbalife of Canada LTD. All rights reserved. Tous droits réservés. Printed in USA. Imprimé aux É.-U. #5001CA-07 REV. 01/15/2021

Rev. 05/19/23
 STATEMENT OF CANCELLATION RIGHTS/BUYER’S RIGHT TO CANCEL
Manitoba, Saskatchewan, Alberta, Yukon, Nunavut, Northwest Territories, Nova Scotia,
British Columbia, Newfoundland and Labrador, New Brunswick and Prince Edward Island

YOU MAY CANCEL THIS CONTRACT FROM THE DAY YOU ENTER INTO THE CONTRACT UNTIL 10 DAYS AFTER YOU RECEIVE
A COPY OF THE CONTRACT. YOU DO NOT NEED A REASON TO CANCEL.
If you do not receive the goods or services within 30 days of the date stated in the contract, you may cancel this contract within one year
of the contract date. You lose that right if you accept delivery after the 30 days. There are other grounds for extended cancellation. For
more information, you may contact your provincial/territorial consumer affairs office.
If you cancel this contract, the seller has 15 days to refund your money and any trade-in, or the cash value of the trade-in. You must then
return the goods.
To cancel, you must give notice of cancellation at the address in this contract. You must give notice of cancellation by a method that will
allow you to prove that you gave notice, including registered mail, fax or by personal delivery.
FOR BRITISH COLUMBIA CONTRACTS ONLY: This is a contract to which the Business Practices and Consumer Protection Act applies.
FOR ONTARIO CONTRACTS ONLY:
YOUR RIGHTS UNDER THE CONSUMER PROTECTION ACT, 2002
You may cancel this agreement at any time during the period that ends ten (10) days after the day you receive a written copy of the
agreement. You do not need to give the supplier a reason for canceling during this 10-day period.
If the supplier does not make delivery within 30 days after the delivery date specified in this agreement or if the supplier does not begin
performance of his, her or its obligations within 30 days after the commencement date specified in this agreement, you may cancel this
agreement at any time before delivery or commencement of performance. You lose the right to cancel if, after the 30-day period has
expired, you agree to accept delivery or authorize commencement of performance. If the delivery date or commencement date is not
specified in this agreement and the supplier does not deliver or commence performance within 30 days after the date this agreement is
entered into, you may cancel this agreement at any time before delivery or commencement of performance.
You lose the right to cancel if, after the 30-day period has expired, you agree to accept delivery or authorize commencement of
performance. In addition, there are other grounds that allow you to cancel this agreement. You may also have other rights, duties and
remedies at law. For more information, you may contact the Ministry of Consumer and Business Services.
To cancel this agreement, you must give notice of cancellation to the supplier, at the address set out in the agreement, by any means
that allows you to prove the date on which you gave notice. If no address is set out in the agreement, use any address of the supplier
that is on record with the Government of Ontario or the Government of Canada or is known by you. If you cancel this agreement, the
supplier has fifteen (15) days to refund any payment you have made and return to you all goods delivered under a trade-in arrangement
(or refund an amount equal to the trade-in allowance). However, if you cancel this agreement after having solicited the goods or services
from the supplier and having requested that delivery be made or performance be commenced within ten (10) days after the date this
agreement is entered into, the supplier is entitled to reasonable compensation for the goods and services that you received before the
earlier of the 11th day after the date this agreement was entered into and the date on which you gave notice of cancellation to the supplier,
except goods that can be repossessed by or returned to the supplier. If the supplier requests in writing repossession of any goods that
came into your possession under the agreement, you must return the goods to the supplier’s address, or allow one of the following
persons to repossess the goods at your address: the supplier, a person designated in writing by the supplier.
If you cancel this agreement, you must take reasonable care of any goods that came into your possession under the agreement until one
of the following happens: The supplier repossesses the goods. The supplier has been given a reasonable opportunity to repossess the
goods and twenty-one (21) days have passed since the agreement was cancelled. You return the goods. The supplier directs you in
writing to destroy the goods and you do so in accordance with the supplier’s instructions.

DROIT DE RÉSILIATION DE L’ACHETEUR

VOUS POUVEZ RÉSILIER LE PRÉSENT CONTRAT À COMPTER DE LA DATE DE CONCLUSION DU CONTRAT, ET CE, PENDANT
UNE PÉRIODE DE 10 JOURS APRÈS LA RÉCEPTION D’UNE COPIE DU CONTRAT. VOUS N’AVEZ PAS BESOIN DE DONNER UNE
RAISON POUR RÉSILIER LE CONTRAT.
Si vous ne recevez pas le bien ou le service au cours des 30 jours qui suivent la date indiquée dans le contrat, vous avez un an, à
compter de la date du contrat, pour résilier le contrat. Toutefois, vous perdez ce droit de résiliation si vous acceptez la livraison après la
période de 30 jours. Le droit de résiliation peut être prolongé pour d’autres raisons. Pour de plus amples renseignements, communiquez
avec votre bureau provincial/territorial de la consommation.
Si vous résiliez le présent contrat, le vendeur doit, dans les 15 jours qui suivent, vous rembourser toute somme que vous lui avez versée
et vous remettre tout bien qu’il a pris en échange ou la somme correspondant à la valeur de ce dernier. Vous devez alors retourner le
bien acheté.
Pour résilier le présent contrat, il vous suffit de donner un avis de résiliation à l’adresse mentionnée dans ce contrat. L’avis doit être donné
par un moyen qui vous permet de prouver que l’avis a réellement été donné, y compris par courrier recommandé, télécopieur ou remise
en personne.

For Nova Scotia and Manitoba Customers: You may give notice of cancellation at the applicable address below:
Herbalife of Canada Ltd. Andrew L. Thompson/Arthur J. Stacey
1791 Barrington Street, Suite 300, TD Centre 2200-201 Portage Avenue
Halifax, NS B3J 3K9 Winnipeg, MB R3B 3L3
Tel: 902-464-1987 Fax: 902-429-5237 Tel: 204-934-2350 Fax: 204-934-0558

Rev. 05/19/23
 FORMULAIRE DE COMMANDE AU DÉTAIL/
Herbalife du Canada Ltée RETAIL ORDER FORM
Herbalife of Canada Ltd. POUR UTILISATION AU QUÉBEC SEULEMENT / FOR USE IN QUEBEC ONLY
7075 Place Robert-Joncas, Suite 113
St-Laurent, Québec H4M 2Z2
T.866-622-1211 F. 514-336-4846 CONTRAT DE VENTE / SALES CONTRACT
Acheteur/Customer Vendeur/Seller
Nom/Name Nom/Name Numéro d’identification/I.D. #

Adresse/Address Adresse/Address

Ville/City Province Ville/City Province

Code postal/Postal Code Téléphone/Phone Code postal/Postal Code Téléphone/Phone

Numéro d’inventaire Quantité / Description/Description Prix unitaire / Total

/ Stock # Quantity Unit Price

No. d’enregistrement de TPS/GST Total

Registration # Expédition et manutention/
No. de permis du commerçant itinérant Itinerant Merchant Permit # Shipping and Handling
Sous-total/Subtotal
Garantie de satisfaction du client:
Si vous n’êtes pas entièrement satisfait de ce produit, veuillez retourner la portion T.P.S./GST
non-utilisée dans les 30 jours suivant l’achat au membre où il a été acheté pour un Sous-total/Subtotal
remboursement complet du prix payé. T.V.Q./QST
Customer Satisfaction Guarantee: Total de la commande/Total Order $
If during the first 30 days after purchasing this product you are not satisfied for
any reason, return the unused portion of the product to the Distributor who sold it
to you for a full refund of the purchase price.
LIVRAISON/DELIVERY: PAIEMENT/PAYMENT: Comptant/Cash Chèque/Check
Visa MasterCard
J’ai reçu la marchandise (initiales)/I have received these goods (initial) No. de carte/Card Number Date d’expiration/Expiry Date
La marchandise sera livrée le/Goods to be Delivered on Signature/Signature
Date de la vente/Date of Sale Endroit de la vente/Location of Sale
Signature de l’acheteur/Customer’s Signature Signature du vendeur/Seller’s Signature

By signing this form, I give consent to my Herbalife Independent Distributor (“Distributor”) to use my information for purposes of processing
my order and providing me with customer service. I further consent to the sharing of my information with Herbalife of Canada LTD
(“Herbalife”) so that they may facilitate my order, validate sales and fulfill compliance obligations. Herbalife or its authorized third parties may
contact me directly for these purposes. I understand that Herbalife may in turn share my data with its affiliates, third party service providers,
and other persons identified in Herbalife’s privacy policy at https://www.herbalife.ca/ privacy-policy, including persons located in
countries outside of Canada (such as the United States and Mexico) that may not offer the same level of data protection as my own country.
For more details, I understand that I may view Herbalife’s privacy policy at https:// www.herbalife.ca/privacy-policy, or contact Herbalife at +1
866-622-1211 or privacy@herbalife.com.
En signant ce formulaire, j'autorise mon distributeur indépendant Herbalife (« le distributeur ») à utiliser mes informations aux fins de traiter
ma commande et de me fournir un service client. Je consens en outre au partage de mes informations avec Herbalife of Canada
LTD (« Herbalife ») afin qu'ils puissent faciliter ma commande, valider les ventes et respecter les obligations de conformité. Herbalife ou ses
tiers autorisés peuvent me contacter directement à ces fins. Je comprends qu'Herbalife peut à son tour partager mes données avec ses
affiliés, des tiers fournisseurs de services et d'autres personnes identifiées dans la politique de confidentialité d'Herbalife à
https://www.herbalife.cafr/privacy-policy, y compris des personnes qui résident dans des pays hors du Canada (comme les États-Unis
et le Mexique) et qui n'offrent pas forcément le même niveau de protection des données que mon propre pays. Pour plus de détails, je
comprends que je peux consulter la politique de confidentialité d'Herbalife à https:// www.herbalife.cafr/privacy-policy, contacter Herbalife
au 866-622-1211 ou consulter privacy@herbalife.com.
------------------------------------------------------------------------------------------------------
FORMULAIRE D’ANNULATION (partie détachable de l’annexe) /
CANCELLATION FORM (detachable from schedule) ( )_
Numéro de téléphone du commerçant itinérant ou du représentant /
À COMPLÉTER PAR LE COMMERÇANT / TO BE COMPLETED BY TH E Telephone number of itinerant merchant or representative
MERCHANT
À / To: _ ( )_
(Nom du commerçant itinérant ou du représentant / Numéro de télécopieur du commerçant itinérant ou du représentant /
Name of itinerant merchant or representative) Fax number of itinerant merchant or representative
_

_ Le cas échéant, adresse technologique du commerçant itinérant ou du représentant /

(Adresse du commerçant itinérant ou de son représentant / Where applicable, technological address of itinerant merchant or representative
Address of itinerant merchant or representative)

VOIR AU VERSO LA DÉCLARATION CONCERNANT LES DROITS D’ANNULATION /

SEE OVERLEAF FOR STATEMENT OF CANCELLATION RIGHTS
BLANC/WHITE - CLIENT/CUSTOMER JAUNE/YELLOW - DISTRIBUTEUR/DISTRIBUTOR
2021 Herbalife International of America, Inc. Tous droits réservés. All rights reserved. Imprimé aux É.-U. Printed in USA. #5010CA-06 1/15/2021

Rev. 05/19/23
 ÉNONCÉ DES DROITS DE RÉSOLUTION DU CONSOMMATEUR
(LOI SUR LA PROTECTION DU CONSOMMATEUR, ARTICLE 58)
Vous pouvez résoudre ce contrat, pour n’importe quelle raison, pendant une période de 10 jours après
la réception du double du contrat et des documents qui doivent y être annexés.
Si vous ne recevez pas le bien ou le service au cours des 30 jours qui suivent une date indiquée dans le contrat, vous avez
1 an pour résoudre le contrat. Toutefois, vous perdez ce droit de résolution si vous acceptez la livraison après cette période
de 30 jours. Le délai d’exercice du droit de résolution peut aussi être porté à 1 an pour d’autres raisons, notamment pour
absence de permis, pour absence ou pour déficience de cautionnement ou pour non-conformité du contrat. Pour de plus
amples renseignements, communiquez avec un conseiller juridique ou l’Office de la protection du consommateur.

Lorsque le contrat est résolu, le commerçant itinérant doit vous rembourser toutes les sommes que vous lui avez versées et
vous restituer tout bien qu’il a reçu en paiement, en échange ou en acompte; s’il ne peut restituer ce bien, le commerçant
itinérant doit remettre une somme correspondant au prix de ce bien indiqué au contrat ou, à défaut, la valeur de ce bien dans
les 15 jours de la résolution. Dans le même délai, vous devez remettre au commerçant itinérant le bien que vous avez reçu
du commerçant.

Pour résoudre le contrat, il suffit soit de remettre au commerçant itinérant ou à son représentant le bien que vous avez reçu,
soit de lui retourner le formulaire d’annulation imprimé ci-dessous ou de lui envoyer un autre avis écrit à cet effet. Le formulaire
ou l’avis doit être adressé au commerçant itinérant ou à son représentant, à l’adresse ci-dessous indiquée sur le formulaire
ou à une autre adresse du commerçant itinérant ou du représentant indiquée dans le contrat. L’avis peut être remis en
personne. Il peut aussi être donné par tout autre moyen. Il est recommandé d’utiliser un moyen qui permet au consommateur
de prouver son envoi: par courrier recommandé, par courrier électronique, par télécopieur ou par un service de messagerie.

STATEMENT OF CONSUMER CANCELLATION RIGHTS

(CONSUMER PROTECTION ACT, SECTION 58)
You may cancel this contract for any reason within 10 days after you receive a copy of the contract along
with the other required documents.

If you do not receive the goods or services within 30 days of the date stated in the contract, you may cancel the contract within
one year. You lose that right if you accept delivery after the 30-day period. There are other grounds for an extension of the
cancellation period to one year, for example if the itinerant merchant does not hold a permit or has not provided the required
security at the time the contract is entered into or if the contract is incorrectly made or worded. For more information, you may
seek legal advice or contact the Office de la protection du consommateur.

If you cancel the contract, the itinerant merchant must refund all amounts you have paid, and return to you the goods received
in payment, as a trade-in or on account; if the merchant is unable to return the goods, you are entitled to receive an amount
of money corresponding to the value indicated in the contract or the cash value of the goods, within 15 days of cancellation.
You also have 15 days to return to the merchant any goods you received from the merchant.

To cancel, you must return the items received from the merchant to the merchant or the merchant’s representative, send the
merchant the cancellation form printed below, or send the merchant another written notice of cancellation. The form or written
notice must be sent to the merchant or the merchant’s representative at the address indicated on the form, or at any other
address indicated in the contract. You may give notice of cancellation in person. You may also use any other method. It is
recommended to use a method that will allow you to prove that you gave notice, including registered mail, email, fax and
courier.

------------------------------------------------------------------------------------------------------
À COMPLÉTER PAR LE CONSOMMATEUR / TO BE COMPLETED BY THE CONSUMER
Date: _ (date d’envoi du formulaire / date on which form is sent) En vertu de l’article 59 de la Loi sur la
protection du consommateur, j’annule le contrat n° / By Virtue of section 59 of the Consumer Protection Act, I hereby cancel the contract
No. (numéro du contrat, s’il est indiqué / contract number, if any) conclu le / made on
(date du contrat / date of contract) à / at:

( )
(Adresse où le consommateur a signé le contrat / Address where contract
was signed by consumer) Numéro de téléphone du consommateur / Telephone number of consumer

(Nom du consommateur / Name of consumer) Numéro de télécopieur du consommateur / Fax number of consumer

(Adresse du consommateur / Address of consumer) Adresse électronique du consommateur / Electronic address of consumer

(Signature du consommateur / Signature of consumer)

BLANC/WHITE - CLIENT/CUSTOMER JAUNE/YELLOW - DISTRIBUTEUR/DISTRIBUTOR

2021 Herbalife International of America, Inc. Tous droits réservés. All rights reserved. Imprimé aux É.-U. Printed in USA. #5010CA-06 1/15/2021

Rev. 05/19/23
 Automatic Payment Service (APS)
Business Authorization Agreement
I acknowledge that this authorization is provided for the benefit of Herbalife of Canada Ltd. (“Herbalife”) and my financial institution and is provided in accordance with the
Rules of the Canadian Payments Association. I warrant and guarantee that all persons whose signatures are required to sign on this account have signed this Agreement
below. I hereby authorize Herbalife to draw from my account and financial institution specified below for the purpose of payments to Herbalife for product, literature and/or
sales promotion orders (The “Herbalife Orders”). The payments for variable monetary amounts will be triggered sporadically in conjunction with the orders I placed with
Herbalife.
This authorization shall remain in effect until property revoked by me in writing at any time. I agree that I must provide reasonable notice (not to exceed 30 days) of revocation
to Herbalife. I understand that Herbalife and/or my financial institution reserve the right to terminate this payment plan upon written notice to me. I may obtain a copy of a
revocation form, or further information on my right to cancel a PAD Agreement, at my financial institution of by visiting www.cdnpay.ca. Revocation of this authorization does
not terminate any contract for goods or services that exists between me and Herbalife.
I acknowledge that my financial institution is not required to verify that a debit has been made in accordance with Authorization Agreement, including verifying the purpose
of payment.
I have certain recourse rights if any debit does not comply with this Agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or
is not consistent with this PAD Agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.cdnpay.ca.
I acknowledge that provision and delivery of authorization to Herbalife constitutes delivery by me to my financial institution and hereby waive any pre-authorization or notice
requirements.
The account that Herbalife is authorized to draw upon is indicated below. Herbalife, in writing, of any change in the account information provided in this authorization prior
to the next due date of the pre-authorized debit from my account. Herbalife will charge $25.00 for returned payments and it may also result in having this payment option
suspended. At any time, should you have any questions regarding APS, you may contact Herbalife of Canada via any of the following:
• Phone: 866-622-1422
• Fax: 514-336-4846
• Email: MontrealSales@herbalife.com
• Address: Herbalife Canada Finance
7075 Place Robert-Joncas #113
Saint Laurent, Quebec, H4M 2Z2
APS is available to :
❖ Supervisors who qualified for 30 days or more (method of payment for all order types)
❖ Distributors (method of payment for Herbalife Advantage Program – HAP orders Only)
DISTRIBUTOR DETAILS (Please print)

Name (as shown on your financial institution’s records) Daytime Telephone Number

Home Address Street City Province Postal Code

Herbalife I.D. Number Name as indicated on Herbalife Distributorship Application

Email Address

Please provide a four-digit personal identification number (P.I.N.) to be used by Herbalife for verification purposes.

DISTRIBUTOR’S BANKING DETAILS (Please print)

IMPORTANT: PLEASE ALLOW 15 DAYS FOR PROCESSING. To avoid delay in processing, you must attach a personalized check marked “VOID”. In
addition, please verify this information with your bank, particularly if using a credit union account as the transit/routing number may be different than what
is on your check or deposit ticket.

Transit Routing Number (9 digits) Bank Account Number Checking

/ /
Herbalife Distributor’s Signature Date

/ /
If joint Bank Account (other Signature) Date

/ /
Herbalife of Canada LTD. Signature Date

Return this completed authorization Agreement to Herbalife of Canada LTD.

Attention: Herbalife Canada Finance 7075 Place
Robert-Joncas #113
Saint-Laurent, PQ, H4M 2Z2
Please keep a copy of this authorization Agreement for your records.
2021 Herbalife International of America, Inc. All rights reserved. Printed in USA.

Rev. 05/19/23
 HERBALIFE OF CANADA LTD. Member Services
7075 Place Robert-Joncas #113 Phone: 866-622-1222
Saint-Laurent, Montreal, Quebec
Fax: 514-336-4846
H4M 2Z2

If you wish to request a change of address, the following procedures must be followed: Do you wish to change your (please check):
• Complete this form.
Email Address
• Mail/Fax this form using the information above to the attention of MEMBER SERVICES
• You may also submit your Change of Address information directly to Herbalife online at Residential Address
MyHerbalife.com (If change is within the same country)
* If this is a change to your country of address,
Allow at least ten days from the date you send this form for the requested change to be made by please contact Member Services, as you will need
Herbalife. All changes will be effective immediately upon completion of the processing of this form to supply additional documentation for this change
by Herbalife. to be processed.

PERSONAL INFORMATION

Last Name First Name Middle Name

Herbalife ID Number

Previous Email Address

New Email Address

Previous Address New Address

Country of Address Country of Address

Street Address Street Address

City Province Postal Code City Province Postal Code

Country Code Area Code Day Phone Country Code Area Code Day Phone

Area Code Evening Phone Area Code Evening Phone

Area Code Fax Area Code Fax

IMPORTANT: If the new address provided above is a P.O. Box, you must fill out the information below and provide a Residential Address (cannot
be a P.O. Box).
New Residential Address

Country of Address

Street Address

City Province Postal Code

Country Code Area Code Day Phone

Area Code Evening Phone

Area Code Fax

Your Signature: Date:

Distributors have Herbalife’s permission to duplicate this document.

Herbalife of Canada, LTD. All rights reserved.

Rev. 05/19/23
 MEMBER SERVICES CUSTOMER REQUEST FOR
Mon-Fri 8:30am to 5:00pm Sat 10:00am to 2:00pm REFUND FORM
Tel: 866-622-1222

HERBALIFE OF CANADA LTD. PLEASE PRINT CLEARLY

6590 Millcreek Dr. Unit #200
Mississauga, ON, L5N 8B3
CUSTOMER: SHIP TO:

Name: Name:

Address: Address:

City: City:

Province: Province:

Postal Code: Telephone: Postal Code: Telephone:

REFUND INFORMATION DISTRIBUTOR:

I request a refund for the purchase price of the following: Name:

Herbalife ID Number:

In the amount of $ I herewith return the unused portion ( ¾ ½ ¼) of the product in

For the following reasons: its original container, along with my receipt to the Distributor for return to
the Company as required under the 30-day Money back Policy after
trying the product for: 1 week or less; 2 weeks; 3 weeks; 4weeks

Refund acknowledged in the amount of : $ Customer signature:

THIS FORM IS NOT VALID WITHOUT A COPY OF THE RETAIL ORDER FORM/INVOICE
This form will help us to make an audit of your Customers by calling them to see exactly what some of the problems have been. This will help us find out
what we can do as a Company to further help our Customers, our Company growth, and most of all you, the Distributor, in technique to better service your
Customers in the field and to build a bigger and better repeat business for your future.

TO HERBALIFE
I certify that I have refunded the above stated amount to Customer. Unused portion of the product in its original container: ¾ ½ ¼ and Customer’s
copy of Retail Sale Form, is hereby returned for replacement in kind.

Distributor Signature: Date:

NOTICE TO DISTRIBUTOR
This form must be completely and properly filled out and signed, to be returned in duplicate, together with the unused portion of the product, in its original
container, along with Customer’s Receipt to the warehouse within thirty days following refund to Customer.

DISTRIBUTION CENTER RECEIPT

Unused portion of product and Customer’s Retail Receipt have been received by the Distribution Center within thirty days following refund to Customer and
product original container has been replaced in kind.

DESCRIPTION OF PRODUCT SHIPPED BY PICK-UP

Warehouse Clerk:

Date: 30-DAY MONEY-BACK POLICY

Distributors have Herbalife’s permission to duplicate this document. Distribution: Send copies to Herbalife. Keep original copy for your records. Herbalife of Canada, LTD. All rights
reserved.

Rev. 05/19/23
 Herbalife of Canada LTD
113-7075 Place Robert-Joncas
St-Laurent, Quebec H4M 2Z2
Tel: 866-622-1211
EARNINGS CERTIFICATION FORM
ROYALTY OVERRIDE / PRODUCTION BONUS AND
10 RETAIL CUSTOMERS / 70% RULE OCUMENTATION
This form must be completed and submitted to Herbalife monthly to comply with the 10 Retail Customers and 70% Rules. Listed below
are several methods the Form can be submitted to Herbalife. No matter which method is chosen, the form must be received by
Herbalife no later than the fifth of each month for the prior month’s activity. (Note: Mail must be postmarked no later than the last
day of the month).

METHODS TO SUBMIT THE FORM:

1. Download the form: [Log on to] ca.MyHerbalife.com [Click on] My Office [Click on] Documents and Policies

2. Submit the form automatically: [Log on to] ca.MyHerbalife.com [Click on] Ten Customer Form [Click on] Submit 10 Customers Form

3. By Mail: Herbalife of Canada LTD

113-7075 Place Robert-Joncas
St-Laurent, Quebec H4M 2Z2
4. By Fax: 514-336-4846
In addition to all the existing Royalty Override requirements, you must also comply in a timely manner with the 10 RETAIL
CUSTOMERS and 70% RULES in order to receive your Royalty Override / Production Bonus payments.

The 10 RETAIL CUSTOMERS RULE means that you must make not less than one sale at retail to each of 10 customers during a given
month.

Other activities that can count towards this requirement are:

A sale directly by the Company to a first level Preferred Customer (except if Preferred Customer is part of your household)

A sale directly made by the Company to a first downline with up to 200 personally purchased Volume Points (and no downline) which
may be counted by the first Upline Supervisor as a sale to one (1) retail customer; and

* A Nutrition Club attendee who consumed products during ten (10) visits to a Nutrition Club within one Volume month, which may be
counted by the Nutrition Club operator as a sale to one (1) retail customer.

The 70% RULE means that at least 70% of the total value of products you acquire each month must be sold or consumed, each month.
Sales may be to retail customers, or wholesale to downlines. For the purpose of this rule, consumption means product consumed at
Nutrition Clubs.

I certify that during the month of , in the year of I have fulfilled the requirements
outlined in the box above. And will, upon request (for verification purposes) furnish to Herbalife the following information concerning such
customers: names, addresses, phone numbers, email addresses and copies of retail receipts (and/or in the case of Club activities, a log
of attendee visits inclusive of attendee names, dates of visits, contact information). I agree to maintain all such records for a period of two
(2) years.

I certify that I have provided my Customers with the Privacy Notice located on the Retail Order Form, or similar notice which, at a minimum
informs the customers that I may share their data with Herbalife, and I have collected their corresponding written consents.

My total personal retail sales for the month total: $

Herbalife ID Number:

Please print name:

Signed: Date:
Keep one copy of this firm for your personal files.
2021 Herbalife International of America, Inc. All rights reserved.

Rev. 05/19/23
 REPURCHASE OF INVENTORY

The opportunity to be a Herbalife Independent Distributor is entirely voluntary. If a Distributor resigns for any reason, the
Distributor is entitled to a full refund of the cost of the IBP (if termination occurs within 12 months of becoming a Distributor)
and any unopened products and Herbalife® products literature and sales aids that are purchased within the previous 12
months and returned to Herbalife. The amount of the refund includes the cost of the items, any taxes, and any
shipping and handling costs on the original delivery and return of the items to Herbalife. Herbalife will also arrange for the
pick-up of items to be returned to Herbalife.

Herbalife will deduct the amount of Royalty Overrides, Commissions, Production Bonuses and any other earnings or
benefits paid on the returned products from the respective earners and adjust qualifications as necessary.

How to Initiate a Repurchase of Inventory

A Distributor may have the right to have Herbalife repurchase resalable inventory, under certain terms and conditions.

To initiate a repurchase of inventory the first step is to complete the required forms, then mail, email, or fax them to
Herbalife.

• Inventory Repurchase Request Form

• Product Return Form
• Literature and Sales Aids Return Form

Mailing Address:
7075 Pace Robert-Joncas, Suite 113
Saint-Laurent, Quebec H4M 2Z2

Email Address:
rrmon@herbalife.com

Fax Number:
310-258-7155

Phone Number:
1-866-622-1222

The forms must be accompanied by or preceded by a signed letter of request for termination, or instead of the letter,
the completed and signed Inventory Repurchase Request Form will be accepted by Herbalife as your request for
termination.

Return Product Authorization

• If you have met the requirements specified on the Inventory Repurchase Request Form and submitted your
forms to Herbalife via any of the methods previously described, please contact Herbalife’s Repurchase
Department at 1-866-622-1222 to arrange the pickup of your inventory.

• Please be aware that all terms and conditions must be met, and to avoid handling delays, each side of your
package must reflect the letters “BB” followed by your Herbalife Identification Number in large print (i.e.,
BB1000000000).

• Once Herbalife has processed the return, the payment due will be issued.

• Herbalife will have no responsibility for items shipped that are outside of Herbalife's Rules and guidelines
provided.

For questions regarding the process, please contact Herbalife’s Refunds & Repurchase Department toll-free at 1-866-
622-1222.

Herbalife©. All rights reserved.

Rev. 05/19/23
Herbalife of Canada Ltd.
7075 Place Robert-Joncas #113
Saint-Laurent, Quebec H4M 2Z2

Inventory Repurchase Request Form

(This form is required.)

This form must be signed, dated, and returned to Herbalife to initiate your request.

• I hereby resign as an Independent Distributor.

• I understand that only unopened products and Herbalife produced literature and sales aids that are
purchased within the last 12 months are eligible for repurchase by Herbalife.

• I understand my refund will be issued for the cost I paid for the items, plus any taxes and any shipping
and handlings costs on the original delivery and return of the items to Herbalife. Herbalife will also
arrange for the pickup of items to be returned to Herbalife.

• I understand that I will be refunded via the same method of payment that was used when I bought the
items. (However, if paid by money order, or wire transfer, the refund will be via check)

• I understand that Herbalife will have no responsibility for items that are not eligible for return.

• I have included proof of purchase for this merchandise (copies of credit card statements, money orders
or cancelled checks), which I did not purchase directly from Herbalife.

• I understand that if I permanently resign within 12 months after the date Herbalife accepted my
Herbalife Distributorship Application and Agreement, I am entitled to a full refund of the cost of my
Herbalife International Business Pack whether or not in resalable condition.

By my signature, I acknowledge and agree to the above.

(Name - Please Print) (Herbalife Identification Number)

(Signature) (Date)

If you agree to the terms and meet the requirements specified above, please contact Herbalife’s Repurchase
Department at 1-866-622-1222 to arrange the pickup of your inventory.

The personal information entered on this form, will be used by Herbalife to process your request, to fulfill our legal and
contractual obligations, and as otherwise described in our privacy policy, located at https://www.herbalife.ca/footer-pages/privacy-
policy/. Herbalife or its authorized service providers may contact you directly for these purposes. Contact us at +1 866- 866-
4744 or Privacy@herbalife.com for more information.

Herbalife©. All rights reserved.

Rev. 05/19/23
Herbalife of Canada Ltd.
7075 Place Robert-Joncas #113
Saint-Laurent, Quebec H4M 2Z2

Products Return Form

In addition to the Inventory Repurchase Request Form, complete this form if your return includes
Herbalife® product inventory.

Name:

Herbalife Identification Number:

Stock Product Description No. of Cases or No. of Herbalife Office

No. Units Use Only

The personal information entered on this form, will be used by Herbalife to process your request, to fulfill our legal and
contractual obligations, and as otherwise described in our privacy policy, located at https://www.herbalife.ca/footer-pages/privacy-
policy/. Herbalife or its authorized service providers may contact you directly for these purposes. Contact us at +1 866- 866-
4744 or Privacy@herbalife.com for more information.

Herbalife©. All rights reserved.

Rev. 05/19/23
Herbalife of Canada Ltd.
7075 Place Robert-Joncas #113
Saint-Laurent, Quebec H4M 2Z2

Literature and Sales Aids Return Form

In addition to the Inventory Repurchase Request Form, complete this form if your return includes
Herbalife literature/promotional items.

Name:

Herbalife Identification Number:

Stock Product Description No. of Cases or No. of Herbalife Office

No. Units Use Only

The personal information entered on this form, will be used by Herbalife to process your request, to fulfill our legal and
contractual obligations, and as otherwise described in our privacy policy, located at https://www.herbalife.ca/footer-pages/privacy-
policy/. Herbalife or its authorized service providers may contact you directly for these purposes. Contact us at +1 866- 866-
4744 or Privacy@herbalife.com for more information.

Herbalife©. All rights reserved.

Rev. 05/19/23
 HERBALIFE OF CANADA LTD 7075
Place Robert-Joncas #113 BANK INFORMATION
St-Laurent, PQ, H4M 2Z2
FORM
Member Services Tel: (866) 622-1222
CANADA ONLY
Member Services Fax: (514) 336-4846

If you wish to enroll or change your Canadian Herbalife earnings through Direct Deposit (Electronic Fund Transfer (EFT) the following procedure
must be followed:

• Complete this form; attach a voided personalized cheque or letter of account verification from your bank.
• Send the original copy to the above address – Attention: Member Services

Enroll in Direct Deposit (EFT) Change Bank Details for Direct Deposit (EFT) Disable Direct Deposit (EFT)

If enrolling by fax or mail a copy of a voided cheque or letter of account verification from your bank is required.
All changes will be made upon completion of this form and processing by Herbalife. Please allow 10 business days for processing.

Distributor Information

Herbalife ID Number

Account Holder First Name (Must Match name on Distributor’s records)

Account Holders Last Name (Must match name on Distributor's records)

Canadian Bank Account Information

Please deposit my future Canadian Herbalife earnings (if any) to the Canadian bank account I have listed below.

Account Holder First Name (Must match name on Bank Statement)

Account Holder Last Name (Must match name on Bank Statement)

Financial
Account Type : Checking Savings Institution:
Bank Routing Number

Bank Account Number

By completing, signing and returning this form to Herbalife, I authorize and consent to Herbalife collecting, using and disclosing my personal
information as required for the purpose of depositing my net earnings and any other sums (“Deposit”) due to me from Herbalife in the Account
identified above. This authorization and consent shall remain effective until revoked by me in writing. Herbalife shall take (i) reasonable steps to
ensure that information that is collected from you is accurate and as up to date as possible and (ii) appropriate steps to keep your information
secure while it is in Herbalife’s possession. I understand and agree that Herbalife shall have no liability for the failure of any deposit to reach my
account in a timely and accurate manner. In the event of any error, Herbalife will fully cooperate to rectify such error. Since no data transmission
can be guaranteed 100% secure, I acknowledge and agree that Herbalife shall not be responsible for any harm that results from any breach of
confidentiality arising out of any communication with, or transmission to, my financial institution in connection with any Deposit.
Account Holder Signature Date

*** Form will not be processed without a copy of a voided check or letter of account verification from your bank ***

Distributors have Herbalife’s permission to duplicate this document.

©2021HERBALIFE INTERNATIONAL OF AMERICA, INC. All rights reserved.

Rev. 05/19/23
 Direct Deposit (EFT) Enrollment Guidelines

Congratulations on choosing Direct Deposit as your earnings payment option!

Below are some guidelines for your reference.

1. Canadian Distributors who are eligible to receive earnings, may opt to receive them via Direct Deposit.

2. The Bank Information Form must be completed in full to enroll and avoid any delays in processing. Both
the Routing Number and Account Number and the Financial Institution number may be obtained from
your Personal or Business Check.

Personal Checks

If enrolling by mail or fax, along with the Bank Information Form, you must provide the follo

 Checking Account: A copy of a voided check is required. Temporary checks will not be
accepted.
Business
SavingsCheck
Account: A letter from the bank must be submitted. The letter should confirm the
Account Holders name, Account Number, and Routing Number.

3. The name of the Account Holder must match Herbalife’s official Distributor records.

4. Local earnings are strictly for local country banks in local currency. Herbalife will not send local
country earnings to banks outside of the local country. For example, a Distributor in Canada will
receive their local earnings in Canadian dollars and will only be sent to a bank within Canada.

5. You may change your payment option at any time. This can be done by resubmitting the Bank
Information Form and checking off the appropriate box.

6. For any changes to your personal information i.e., Name Change, Checks Payable or Transferring
Distributorship or to Add, Modify or Cancel Direct Deposit (EFT) Option, a proper procedure will
need to be followed to update Herbalife’s official records. An updated Bank Information Form must
also be resubmitted by mail or fax.

7. If the Direct Deposit option is rejected due to bank account error, a check will automatically be generated
and mailed to your current address on record. A courtesy call will also be made.

8. All changes will be effective upon completion of processing by Herbalife. Processing will take
approximately 3 days upon receipt of information due to bank verification. You will be contacted if your
form is incomplete.

9. When submitting your Bank Information Form, you must provide the following:

• A copy of a voided check is required. Temporary checks will not be accepted.

• Or a letter from the bank for account verification. The letter should confirm the Account
Holders name, Account Number, and Routing Number.

© 2021. Herbalife International of America. All Rights Reserved.

Rev. 05/19/23
 HERBALIFE OF CANADA LTD
7075 Place Robert-Joncas #113
CHANGE OF BANK INFORMATION
Saint-Laurent, PQ, H4M 2Z2 FORM
Member Service Tel: (866) 622-1222 CANADA ONLY
Member Service Fax: (514) 336-4846

If you wish to change your Canadian Herbalife earnings through Direct Deposit (Electronic Fund Transfer (EFT)) the following procedure must be followed:
• Complete this form.
• Attach a voided personalized cheque or letter of account verifcation from your bank.
• Send the original copy to the above address – Attention: Member Services
All changes will be made upon completion of this form and processing by Herbalife. Please allow 10 business days for processing.
□ Name Change □ Cheque to replace Direct Deposit
□ Transferring Distributorship □ Cheque payable to corporation
□ Change in banking information* □ Cheques payable to a non-corporation (i.e. Spouse,
*Notary signature required.
partnership, non-incorporated company)

Distributor Information
□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□
Herbalife ID Number
□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□
Last Name
□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□
First Name Middle Initial
□□□ □□□□□□□ □□□ □□□□□□□
Day Phone Evening Phone

Please deposit my future Canadian Herbalife earnings (if any) to the Canadian bank account I have listed below.
□□□□□□□□□□□□□□□□□□□□□□□
Account Holder Name
□□□□□□□□□□□□□□□□□□□□□□□ □□□□
Bank Name Financial Institution
□□□□□□□□□□□□□□□□□□□□□□□
Branch/Transit Number
□□□□□□□□□□□□□□□□□□□□□□□
Account Number
Canadian bank account information to be closed listed below.
□□□□□□□□□□□□□□□□□□□□□□□
Account Holder Name
□□□□□□□□□□□□□□□□□□□□□□□ □□□□
Bank Name Financial Institution
□□□□□□□□□□□□□□□□□□□□□□□
Branch/Transit Number
□□□□□□□□□□□□□□□□□□□□□□□
Account Number
By completing, signing and returning this form to Herbalife, I authorize and consent to Herbalife collecting, using and disclosing my personal information as required for the
purpose of depositing my net earnings and any other sums (“Deposit”) due to me from Herbalife in the Account identified above. This authorization and consent shall remain
effective until revoked by me in writing. Herbalife shall take (i) reasonable steps to ensure that information that is collected from you is accurate and as up to date as possible
and (ii) appropriate steps to keep your information secure while it is in Herbalife’s possession. I understand and agree that Herbalife shall have no liability for the failure
of any deposit to reach my account in a timely and accurate manner. In the event of any error, Herbalife will fully cooperate to rectify such error. Since no data
transmission can be guaranteed 100% secure, I acknowledge and agree that Herbalife shall not be responsible for any harm that results from any breach of confidentiality
arising out of any communication with, or transmission to, my financial institution in connection with any Deposit.

Account Holder Signature: Notary Signature:

New Account Holder Signature: Date:

Distributors have Herbalife’s permission to duplicate this document.
©2021 HERBALIFE INTERNATIONAL, INC. All rights reserved.

Rev. 05/19/23
Nutrition Club Operator’s Advisory
This Nutrition Club is operated by Herbalife Independent Distributor
(“Operator”), .
Operator’s mailing address is ,
and Operator’s business phone number is .
Operator, not Herbalife, is responsible for all of the activities related to this
Nutrition Club.
Nutrition Clubs are social gatherings, bringing people together with a focus on
good nutrition. They are not retail stores or outlets, nor are they restaurants.
Registered Club attendees may carry out one shake per day from the Club, but
only in unbranded containers of not more than 350 mL (12 oz.) in capacity.
Carry-out of shakes may only be for the personal consumption of that Club
attendee, or another registered Club attendee. Carry-out is limited to shakes
and does not include teas, Formula 1 pies or Herbal Aloe.
Nutrition Club fees cover general operational costs and do not represent the
price or cost of products. Participants may share their experiences after having
used the products, but must always remember that the products are not
intended to diagnose, treat, prevent or cure any disease or medical condition.
Income reported in Nutrition Club materials, or in oral testimony at Club
gatherings, is applicable to the individuals (or examples) depicted and not
typical.
A typical participant in the Herbalife plan earns approximately $444 based on
the year 2023. The incomes presented are applicable to the individuals
depicted and are not a guarantee of your income, nor are they typical. For
additional financial performance data, see the Statement of Typical
Compensation paid by Herbalife at Herbalife.com and MyHerbalife.com.

Rev. 05/19/23
Rev. 05/19/23
 Hygiene and Sanitary Practices Advisory
for Nutrition Club Operators
Although Nutrition Clubs are not restaurants, carry-outs, or any other
type of food service establishment, Herbalife expects Nutrition Club
Operators to adopt the highest standards of hygiene and sanitary
practices. Listed below are the core principles of good hygiene and
sanitation that are always required.

• Keep your Club, and particularly your entire kitchen area, clean at all times.
• Keep all tools and utensils used in food preparation, and in particular
blenders and cutting boards, clean at all times.
• Keep your hands and forearms clean at all times by washing them frequently
with antibacterial soap and warm water.
• Always use purified (or boiled) water in preparing the Club’s complimentary
beverages.
• Inspect fruits and vegetables for freshness and quality, and wash them prior to
use.
• Always use disposable cups.
• Clean up any spillage immediately, and remove all trash promptly

Rev. 05/19/23
Rev. 05/19/23
Healthy Weight Challenge Participation Agreement
Thank you for your interest in the Healthy Weight Challenge! Through the Challenge, Herbalife
Distributors are able to help participants work toward their weight-management goals. We want you
to have a great time as you have fun and meet new friends at our Healthy Weight Challenge.
Remember that any reasonable diet or weight-management program includes exercise and sensible
meals, and it’s always a good idea to consult your primary physician before starting an exercise or
weight- management program.
The Distributor(s) responsible for this Challenge:

Name(s):

Contact Information:

Please read this document carefully and sign it to confirm that you understand all of the general terms of
the Healthy Weight Challenge.
• In return for your Participation Fee of $ and upon signing this document, you are entitled
to participate in the Healthy Weight Challenge identified below and you will be eligible for the various
prizes and/or rewards, which are awarded upon its conclusion. You will also attend weekly weigh-
ins where you will have the opportunity to ask questions, and receive information.
• This Healthy Weight Challenge begins the week of / , 20 and ends the week of
/ , 20 .
• Members are independent businesspersons; they are solely and exclusively responsible for the
operation and details of each Healthy Weight Challenge.
• The purchase or consumption of Herbalife products in conjunction with your
participation is recommended, but not required.

• The Participation Fee of $ covers all prizes rewards, plus minimal operational costs.
• The Weight-Gain Fee is $1* per 500 kilograms for weight gained since the last recorded weigh-in.
• The Absence Fee is $5* for each absence. One (1) absence is allowed without penalty.
• The Participation Fee is fully refundable if requested by the participant within the first 48 hours of
the Challenge start date.
• Healthy Weight Rewards are awarded to the top 3 weight losers as follows:
0 1st Place: 50 percent will be awarded to the person who has lost the greatest percentage of
his/her body weight by the end of the Challenge.
0 2nd Place: 30 percent will be awarded to the person who has lost the next greatest percentage
of his/her body weight by the end of the Challenge.
0 3rd Place: 20 percent will be awarded to the person who has lost the next greatest percentage
of his/her body weight by the end of the Challenge.

*Amount is in CAD dollars.

Rev. 05/19/23
 • A Centimeters Reward is awarded to the participant who loses the most centimeters and is not also
a top 3 weight loser; this winner receives all money collected from Weight-Gain and Absence Fees.
• The odds of receiving a Healthy Weight Reward depend on the skill in losing weight and the
number of participants within the Challenge. Rewards will be given at the last Challenge Meeting.
• If, after reading this document, you have any further questions about the Healthy Weight Challenge,
do not hesitate to ask the Distributor(s) listed in this Agreement.
• As a participant, you should communicate regularly and fully about your progress and never
hesitate to ask questions, so you can receive the appropriate information.
• You must be at least 18 years of age to enter a Healthy Weight Challenge;
• Herbalife Distributors are independent businesspersons, and as such they may, or may not
have received formal training as counselors, dietitians or otherwise. Herbalife assumes no
responsibility or liability with regard to such activities.

❑ By checking this box, I agree to receive information about this Healthy Weight Challenge
and Herbalife products, services & promotions via email from the Distributor(s) listed in
this Agreement.
.
❑ By checking this box, I agree that the Distributor(s) listed in this Agreement may provide
Herbalife with my contact information so that I can receive information about Herbalife
products, services & promotions via email directly from Herbalife.

I, , have reviewed and agree to all of the above.

( PRINT NAME)

Signature: Date: / /

Address:

City: Province/Territory: Postal Code:

Phone ---------------------------------

Email:

How did you hear about this Challenge? (please check)

□ Prior participant □ Referred by a friend (name):
□ Newspaper ad □ Postcard (colour of postcard or name listed):
□ Other:

Rev. 05/19/23