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Contact Information Please provide the following contact information: First Name Last Name Street Address Address (cont.) City State/Province Zip/Postal Code Country Home Phone E-mail Are you a current client?     Yes No Best time to call:     PRODUCTS "LITES" Protein Bars Packaged 14 per box [Nutritional Info. = Cal's / Fat / Carb's / Protein] $29.00 / box Peanut Butter Milk chocolate covered thick and creamy peanut butter. 160 / 6g / 12g / 15g Qty: Boxes Cookie Dough Bring back childhood memories with our sweet and chewy cookie dough. 180 / 4g / 31g / 8g Qty: Boxes Honey Nougat Perfect balance of texture and flavor. If you're a nougat connoisseur this is for you! 180 / 4.5g / 29g / 8g Qty: Boxes Carmel Crunch     This bar boasts milk chocolate over a thick layer of caramel and chewy nougat. 155 / 3.5g / 15g / 15g Qty: Boxes Dark Choc Smore's     Rich dark chocolate covering chewy Marshmallow and graham cracker. 160 / 5g / 18g / 15g Qty: Boxes Peanut Butter Caramel       Qty: Boxes Peanut Butter Crisp     A mouth watering, nutty, crunchy, peanut-buttery, Crisp. 160 / 4.5g / 15g / 15g Qty: Boxes Peanut Butter and Jelly     A childhood favorite that never gets old. Now even creamier and more nutritious! 170 / 6g / 16g / 12g Qty: Boxes Choc Graham Cracker Crunch     A crispy, crunchy and chocolaty Graham Cracker Bar. 160 / 5g / 18g / 15g Qty: Boxes Cinnamon Crunch       Qty: Boxes Choc Caramel Delight        Qty: Boxes Choc Mint Crunch       Qty: Boxes Rocky Road     Blissful and chewy marshmallow and nutty chocolate. Dreamy!! 170 / 7g / 15g / 13g Qty: Boxes Lemon Crunch     Looking for crunchy and tangy goodness? You won't be sorry with this one! 160 / 3.5g / 16g / 15g Qty: Boxes Oatmeal     Cinnamon oatmeal covered with a sweet yogurt coating. Now that's a breakfast! 150 / 3g / 13g / 15g Qty: Boxes Blueberry Pomegranate       Qty: Boxes   "LITES" Drinks Packaged 14 per box [Nutritional Info. = Cal's / Fat / Carb's / Protein] $29.00 / box Vanilla Shake / Pudding ...a cold milkshake, a creamy pudding or add some fruit and enjoy as a smoothie. 100 / 1.5g / 7g / 14g Qty: Boxes Chocolate Shake   Qty: Boxes Double Chocolate Pudding Rich and creamy, this double chocolaty pudding will also make a great fruit dip! 80 / .5g / 9g / 12g Qty: Boxes Strawberry Shake   Qty: Boxes Hot Chocolate There's nothing better than hot creamy cocoa when it's cold out. 70 / .5g / 6g / 12g Qty: Boxes Lemonade Nutritious and refreshing! Just add water and ice. 60 / 0g / 1g / 12g Qty: Boxes   Snacks Description / [Price] Nutritional Info. = Cal's / Fat / Carb's / Protein Purchase Chocolate Soy Snacks   Qty: Boxes Almond Biscotti   Qty: Boxes Honey Mustard Double Bites Honey mustard flavored bite size snacks. [6 bags / $10.00]      130 / 2.5g / 18g / 10g Qty: Boxes Cheddar Cheese Double Bites Crunchy, and cheddar cheesy snacks. [6 bags / $10.00]      130 / 3g / 17g / 10g Qty: Boxes BBQ Chips   Qty: Boxes Vanilla Wafers   Qty: Boxes Chocolate Meal Replacement VHP (easy dissolve powder) w/shaker cup   Qty: Boxes Vanilla Meal Replacement VHP (easy dissolve powder) w/shaker cup   Qty: Boxes Strawberry Meal Replacement VHP (easy dissolve powder) w/shaker cup   Qty: Boxes   Supplements Description / [Price] Purchase Vitamax 30 day supply / $11.00 Qty: Boxes Essential Fatty Acids 3/6/9 30 day supply / $19.00 Qty: Boxes "Reduce Plus" (CLA) 30 day supply / $29.00 Qty: Boxes "Xcel" 30 day supply / $89.00 Qty: Boxes Carb Blocker Plus 30 day supply / $39.00 Qty: Boxes Super G1 hcg 21 - 30 day supply / 89.00 Qty: Boxes Sublingual B12 21 - 30 day supply / $29.00 Qty: Boxes

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