Enagic United states
Finance Application Form



Mailing Address (must match W9)

Billing address (if different from mailing address)

Shipping address (if different from mailing address)

Enroller and sponsor infomation (if applicable)

Payment amount

**Please note the first payment date must be within 45 days from purchase date. Payment must be on the first or the 15th of each month.

Credit card information

*** Please fill out Alternate Payer Form if someone beside the applicant will be making down payment and/or monthly payment. ***