PRODUCT ORDER FORM(UNITED STATES/CANADA/PUERTO RICO)

1 - 30 Pack Fuel1 - 30 Pack Ignite1 - 30 Pack Recover1 - Ripstix Trimr Bottle + FREE Enrollment

1 - 60 Pack Hydrate1 - 30 Pack Fuel2 - 30 Pack Ignite2 - 30 Pack Recover1 - Ripstix Trimr Bottle+ FREE Enrollment

2 - 60 Pack Hydrate2 - 30 Pack Fuel4 - 30 Pack Ignite4 - 30 Pack Recover1 - Ripstix Trimr Bottle+ FREE Enrollment

2 - 60 Pack Hydrate2 - 30 Pack Fuel4 - 30 Pack Ignite4 - 30 Pack Recover1 - Ripstix Trimr Bottle+ FREE Enrollment+ FREE Ripstix Founder Duffel Bag

Basic Training Kit

MVP Starter Kit

Pro Builder Kit

Ripstix Founder Kit*

$220

$330

$660

$660

150PV

250PV

500PV

500PV

HARDER

BETTER

FASTER

STRONGER

*Ripstix Founder Kit is available for a limited time only. For complete rules and details about how to become a Ripstix Founder, refer to the full Ripstix Founder document.

Product Selection:

p Basic Training Kit ($220 USD/150 PV)

p MVP Starter Kit ($330 USD/250 PV)

p Pro Builder Kit ($660 USD/500 PV)

p Ripstix Founder Kit ($660 USD/500 PV)

QTY AUTOSHIP PRODUCT DESCRIPTION (Please write below) PRICE*

To place an order: 1.801.494.2323ENROLLMENT APPLICATION

6 INITIAL ORDER

TOTAL

AutoShip is a program of convenience that automatically charges and ships the products of your choice approximately every 4 weeks after the initial order. *Prices shown DO NOT include shipping and handling.

Customer Initials

2 SPONSOR INFORMATION

SPONSOR’S NAME PHONE NUMBER SPONSOR’S ID NUMBER

4 ENROLLMENT FEE / PAYMENT

3 PLACEMENT INFORMATION (optional)

PLACEMENT NAME PLACEMENT ID NUMBER CIRCLE CHOICE (REQUIRED) LEFT RIGHT

Based on the information provided in this section, you will be placed in the first available Left or Right position of the Placement Name and ID Number provided below. If no Placement Name or ID Number is provided in this section, you will be placed in the first available position on the Left or Right side of your Sponsor (listed above).

8 TERMS AND CONDITIONS

Applicant/Authorized Party’s Signature and Title_____________________________________________ Date __________

By signing below, I understand and have read and agree to abide by the Zija Policies & Procedures/Terms and Conditions, and that this enrollment form is abbreviated and not intended as a substitute for full disclosure of the Zija Policies & Procedures/Terms and Conditions. I understand that a complete disclosure of such documentation is available upon my request. I authorize my enrolling Sponsor to process this initial order with the information I have supplied herewith. In addition, I authorize Zija to process my order and to charge my credit card referenced above.

5 PAYMENT (check one) p Visa p Mastercard p AMEX p Discover

CREDIT CARD NUMBER EXPIRATION DATE

NAME AS SHOWN ON CARD SIGNATURE OF CARDHOLDER

BILLING ADDRESS CITY STATE/PROVINCE POSTAL CODE

1 NEW ENROLLEE INFORMATION (required) p Individual/Sole Proprietor p Joint Applicants p Partnership p Corporation

LAST NAME

POSTAL CODE

POSTAL CODE

DATE OF BIRTH (MM/DD/YY)

FIRST NAME MIDDLE INITIAL

BUSINESS NAME (IF DIFFERENT FROM APPLICANT’S NAME)

MAILING ADDRESS

SHIPPING ADDRESS (IF DIFFERENT FROM MAILING)

PHONE NUMBER E-MAIL ADDRESS

( )( )

( )

OTHER PHONE / FAX

CITY

CITY

STATE/PROVINCE

STATE/PROVINCE

I understand that the $39 Enrollment Fee to become a Ripstix Distributor is waived with the purchase of any Ripstix System, which includes a Ripstix Business Kit containing sales and demonstration materials as well as company information created by Zija. I understand a yearly renewal fee of $25 is required to continue as a Distributor. I authorize Zija to charge the $25 annual renewal fee to my credit card as it becomes due. I understand a renew-al fee is applicable annually, starting thirty (30) days prior to my enrollment anniversary date to maintain my Distributor status.

©2014 Zija International, Inc. All Rights Reserved. (09.14)

7 AUTOSHIP ORDER