Shaklee Purchase Order Form / Membership Application Form

In the Case of Membership Application:

- Kindly fill in : 1) Your (and Spouse's) Full Name (as per I/C) and your I/C No . 2) Your Mobile Number 3) Please fill in Current Address 4) Maybank account number (if any)

* Required

You would like to... *Purchase Shaklee Products Make an Enquiry Join Us As Member

Full Name (as per I/C) ** only for those applying for membership

Your I/C Numberonly necessary for Shaklee Membership Applicants

Your Mobile Number *in order for us to contact you sooner

Your Spouse's Full Name (If Married); I/C Number and Mobile Number* only for Shaklee Membership - One membership for one couple, valid whole lifetime.

Current Permanent AddressApplicable for Membership Application - Shaklee Bonus Statements will be delivered to this address, please remember to include your postcode (for Malaysia)

Email Address *

Your Maybank Account NoMake sure it is active, Shaklee will be transferring your bonuses here

Choose The Product(s) You Would Like to Buy

Product List

•  ESP (Energizing Soy Protein)
•  Lecithin
•  SR Vita-C 500mg
•  Vivix
•  Vita-Lea
•  B-Complex
•  DTX Complex
•  Nutriferon
•  Meal Shakes
•  Performance Drink
•  Cinch Shake Mix
•  Cinch Energy Tea Mix
•  Peppermint Ginger Plus
•  Alfalfa Complex
•  Carotamax
•  Ostematrix
•  Herb-Lax
•  Zinc Complex
•  Garlic Complex
•  Vitamin E Complex
•  GLA Complex
•  Omega Guard
•  CoQHealth Plus
•  Collagen Powder
•  Other: 

Any Other Specific Questions ? Requests?

Write down your concerns here ........