Enagic Australia
trifecta Order Forms

PRODUCT NUMBER 1

Please download a copy of this form for your records

Referenced documents: Enagic Australia Product Order Form Distributor

Name

Date of Birth

Drivers Licence/Passport Number

Phone

Address

City

State

Postcode

Shipping address if different from above * Must be a street address not a PO BOX

I agree to receive communication from Enagic

Pick up from Enagic Australia Office

Name of Person Picking Up

Signature

Clear

Bank Information ( To receive your enagic commissions )

Name of Bank

Account Holder Name

Name Of Branch

BSB

Account Number

Sponsor Information

Sponsor Name

Sponsor ID

Product Ordered ( Leave Blank if unsure)

Product Ordered

Unit Price

GST

Shipping

Total

Payment Method

Credit/Debit Card Information

Card Type

Credit Card Number

Credit Card Expiry Date

CCV

Card Holders Name

Card Holders Signature

Clear

Applicant Signature

Clear

Date Signed

Who is your DBS specialist?

PRODUCT NUMBER 2

Please download a copy of this form for your records

Referenced documents: Enagic Australia Product Order Form Distributor

Name

Date of Birth

Drivers Licence/Passport Number

Phone

Address

City

State

Postcode

Shipping address if different from above * Must be a street address not a PO BOX

I agree to receive communication from Enagic

Pick up from Enagic Australia Office

Name of Person Picking Up

Signature

Clear

Bank Information ( To receive your enagic commissions )

Name of Bank

Account Holder Name

Name Of Branch

BSB

Account Number

Sponsor Information

Sponsor Name

Sponsor ID

Product Ordered ( Leave Blank if unsure)

Product Ordered

Unit Price

GST

Shipping

Total

Payment Method

Credit/Debit Card Information

Card Type

Credit Card Number

Credit Card Expiry Date

CCV

Card Holders Name

Card Holders Signature

Clear

Applicant Signature

Clear

Date Signed

Who is your DBS specialist?

PRODUCT NUMBER 3

If your 3rd product is UKON please scroll down until you see the UKON form.

DO NOT FILL IN THE FORM DIRECTLY BELOW

Please download a copy of this form for your records

Referenced documents: Enagic Australia Product Order Form Distributor

Name

Date of Birth

Drivers Licence/Passport Number

Phone

Address

City

State

Postcode

Shipping address if different from above * Must be a street address not a PO BOX

I agree to receive communication from Enagic

Pick up from Enagic Australia Office

Name of Person Picking Up

Signature

Clear

Bank Information ( To receive your enagic commissions )

Name of Bank

Account Holder Name

Name Of Branch

BSB

Account Number

Sponsor Information

Sponsor Name

Sponsor ID

Product Ordered ( Leave Blank if unsure)

Product Ordered

Unit Price

GST

Shipping

Total

Payment Method

Credit/Debit Card Information

Card Type

Credit Card Number

Credit Card Expiry Date

CCV

Card Holders Name

Card Holders Signature

Clear

Applicant Signature

Clear

Date Signed

Who is your DBS specialist?

UKON DD ORDER

Please download a copy of this form for your records

Referenced documents: Enagic Australia/New Zealand Ukon DD Application Form

Applicants Name

UkonDD Continue ID

Date of Birth

Drivers License/Passport Number

Address

Tel. No. (Home)

Tel. No. (Mobile)

Bank Information

Bank Name

Branch Name

Account Holders name

BSB

Account Number

Sponsor Details

Sponsor Name (your name if you are purchasing a Trifecta)

Sponsor Machine ID

Product

Vegetarian Version

UKON A Capsules: JPY 76,000 | UKON C Soap: JPY 76,000

Standard Distributor Price

UKON A Capsules: JPY 68,000 | UKON C Soap: JPY 68,000

E8PA Cardholder Price

Shipping: UKON A Capsules: JPY 3,700 | UKON C Soap: JPY 7,300

Shipping Cost

I authorise Okinawa Foods to automatically renew and charge my card for payment at the end of each 4-month term unless I submit a cancellation form 1 month prior to the end of the term

Payment

Card Type

Total Amount

Recipient’s Name

Recipient’s Tel. No.

Postcode

Shipping Address (No P.O. Box)

Please read T&C before signing

Applicant Signature

Clear

Date

Credit Card Payment (Credit Card Holder)

Name

Address

City

State

Postcode

Tel. No. (Home)

Tel. No. (Mobile)

E-mail

Product

Credit Card Details

Cardholder’s Name

Mastercard / Visa

Card no.

Expiry Date

CVV

Total Amount JPY

Cardholder’s Signature

Clear

Purchaser’s Name and Distributor ID if different from the Credit Card holder

Name

Distributor ID

Who is your DBS specialist?

POLICIES AND PROCEDURES

Please download a copy of this form for your records

Referenced documents: Enagic Australia Policies and Procedures

First Name

Last Name

Home Phone

Address

Mobile

Distributor Name

Distributor ID

Signature

Clear

Date

Who is your DBS specialist?

RETURNS POLICY

SUPPORTING DOCUMENTS

Please load your documents here to support your application

First Name

Last Name

Licence Photo Front

License Photo Back

Photo of Credit Card for Epayments - Front

Photo of Credit Card for Epayments - Back

Passport (if do not have drivers licence)

Proof of address within the last 3 months ( Only Required for e-payment)

Who is your DBS specialist?

ONCE YOU HIT SUBMIT YOUR DOCUMENTS WILL BE SENT TO THE DBS TEAM

PLEASE ENSURE YOU HAVE COMPLETED ALL THE FORMS ABOVE

IF YOU ARE WANTING TO PURCHASE WITH FINANCE OR EPAYMENT PLEASE COMPLETE THE ADDITIONAL APPLICATION FORMS BELOW

EPAYMENT

Please download a copy of this form for your records

Referenced documents: Enagic Australia E-Payment Agreement

Application Date

Applicant's Name

Mobile

Address

Sponsors Name

Sponsor Distributor ID

Sponsors Email

Sponsors Contact Number

Signature

Clear

Date

Product Ordered

Price

Initial Payment

Instalment Amount

Number of Months

Who is your DBS specialist?

FINANCE

Please download a copy of this form for your records

Referenced documents: Enagic Australia Finance Authorisation to Pay Form

Name

Total Finance Amount

Customer ID

Interest Rate

Finance Term

Applicant 1 Signature

Clear

Applicant 1 Name

Date

Applicant 2 Signature

Clear

Applicant 2 Name

Date

Who is your DBS specialist?

Enagic Australia trifecta Order Forms

Pick up from Enagic Australia Office

Bank Information ( To receive your enagic commissions )

Sponsor Information

Product Ordered ( Leave Blank if unsure)

Credit/Debit Card Information

Pick up from Enagic Australia Office

Bank Information ( To receive your enagic commissions )

Sponsor Information

Product Ordered ( Leave Blank if unsure)

Credit/Debit Card Information

Pick up from Enagic Australia Office

Bank Information ( To receive your enagic commissions )

Sponsor Information

Product Ordered ( Leave Blank if unsure)

Credit/Debit Card Information

Bank Information

Sponsor Details

Product

UKON A Capsules: JPY 76,000 | UKON C Soap: JPY 76,000

UKON A Capsules: JPY 68,000 | UKON C Soap: JPY 68,000

Shipping: UKON A Capsules: JPY 3,700 | UKON C Soap: JPY 7,300

Payment

Please read T&C before signing

Credit Card Payment (Credit Card Holder)

Credit Card Details

Purchaser’s Name and Distributor ID if different from the Credit Card holder

Enagic Australia
trifecta Order Forms