Forever Living Products

Tel: 022 - 6641 4000 Fax: 022 - 6641 4007 Email: orders@flpindia.net

ORDER FORM Order Date: DD/MM/YYYY

FBO DETAILS
FBO ID No: FBOs Name:
Sponsor ID No: Sponsors Name:

PAYMENT DETAILS (Please tick the appropriate box)

Cash Cheque / DD No: Credit/Debit Card Direct Deposit

(Please fill cash denomations below) (Please attach deposit slip)

DELIVERY DETAILS (Please fill in details only if delivery is not at the counter)
Delivery Address:

Pincode: Tel. No. (with STD code) Mobile No.

Each Product Order must be of minimum Rs. 1,000/- including taxes

ORDER DETAILS
Product Code Quantity Product Description Amount

Total Case Credits : Denominations Quantity Amount

1000 X
Total Amount:
500 X
1. Please refer to the Price List while filling this Order Form 100 X
2. Please enter all details. Orders will not be accepted with incomplete details.
50 X
Name of the person placing the order: 20 X
10 X
5X
Contact Number:
Coins
Signature: Total
Less: Bill Amount (To be filled
Please check your cash amount & balance refund BEFORE leaving the counter Refund (if any) by Cashier)
 Forever Living Products
Tel: 022 - 6641 4000 Fax: 022 - 6641 4007 Email: orders@flpindia.net

DIRECT DEPOSIT CLAIM FORM CUM DECLARATION

Name of the person placing the order having FBO ID#
I, ________________________________________________ hereby
declare the following:
1. That, I am placing the order(s) listed in the table below against the deposit of Rs. ___________________ on
DD/MM/YYYY
________________ in AXIS / SBI / HSBC Bank at ________________________________________ branch having
branch code no __________________ deposited by Mr./ Mrs. ___________________________________________
2. That, the below mentioned order(s) is/are being placed on the express authority of the person who has deposited the
said amount in the Bank as named hereinabove.
3. That, the products/literatures against the below mentioned order(s) shall be collected from the FLP counter by me or
by Mr./ Mrs. ______________________________________________________ (photo ID mandatory) or shall be dispatched
to the address(es) mentioned in such order(s) on the express authority of the person who has deposited the said
amount in the bank as named hereinabove.
Invoice/RCP No
Sr No FBO ID# FBO Name Order Amount
(by FLP Staff)
1
2
3
4
5
6
7
8
9
10
Attach additional sheet if required for more details Total Amount (should be equal to deposited amount):

ADDITIONAL DETAILS (Kindly tick the appropriate box):

Payment Method:
Direct Deposit NET Banking
(If ticked, transaction number mandatory): _______________________________

Attached Deposit Slip:

Original Photocopy

Attached copy of Photo ID of person placing the order (mandatory if photocopy of deposit slip is attached):
Passport Driving License Voter ID

UID (Aadhar) Card PAN Card (additional address proof required)

Date:________________ __________________ ______________________

Place:________________ Contact Number Full Signature of the
Person placing the Order
FORM WILL NOT BE ACCEPTED WITH INCOMPLETE DETAILS.
FOR OFFICE USE ONLY

Confirmation Code:____________________________ FLP Executive Signature:_________________________

January 2016