Customer Benefits                                       4609 West 65th South
Idaho Falls, ID 83402 U.S.
                                 Cancellation Form
1. Customer Information
MELALEUCA CUSTOMER NUMBER                          TELEPHONE NUMBER
  107479471                                           705-818-1888
CUSTOMER NAME
  Luc Trahan
ADDRESS
  4607 50A ave
CITY                                               PROVINCE            POSTAL
  Beaumont                                            AB                  T6W 4G7
2. Loss of Membership Benefits
I acknowledge and agree that I will lose the following membership benefits:
    30%-50% discount on superior wellness products              Melaleuca Member Discount on Riverbend Black Label
    Valuable Loyalty Shopping Dollars                           Beef
    Access to Melaleuca Retail Partners providing significant   Exclusive Member Special Offers
    discounts at major retailers like Home Depot, Kohls, and    All unspent Loyalty Shopping Dollars will be forfeited
    Old Navy                                                    Catalogs, brochures and other important information on
    Valuable monthly savings coupons                            unique products that can improve your health and
    Savings on Melaleuca Home Security Systems                  wellbeing
    Savings on InfoGuard - Advanced Identity Protection         Savings on mobile phones and plans from MelaCom
                                                                Wireless
3. Signature
Please cancel my Preferred Customer Agreement. I understand that I will no longer receive Melaleuca Customer benefits.
Customer Signature:                                                                     Date:
(this Customer Benefits Cancellation Form is not valid unless signed by the customer)
Spouse Signature:                                                                       Date:
 Please contact me about reactivating my account in:       30 days     60 days    90 days
5. Send
This form must be printed, signed and mailed, faxed, or emailed to Melaleuca:
          Mail:                                      Fax:                           Email:
          Melaleuca Data Entry                       (888) 528-2090                 Scan, attach, and email to:
          4609 West 65th South                                                      myaccount@melaleuca.com
          Idaho Falls, ID 83402 U.S.
Your Customer benefits will be cancelled within 24 hours of receipt of this cancellation form. However, if the form is
received on a weekend or a national holiday, it will be processed the next business day. All cancellation forms received by
5:00 PM Mountain Time on the last day of the month will be processed and effective that month. Note: When you cancel
your Customer status, you lose your rights to a 30 - 40% customer discount. However, you are welcome to shop anytime
for any Melaleuca products at the regular price. Simply give us a call at 1-800-282-3000, we’d be glad to help!