Welcome form

1

Name* This field is required.

First Name

Last Name

2

Please fill out your valid email address* This field is required.This will be where I send you information, please check your inbox and junk mail within 72 hours of submitting this form!

example@example.com

3

Instagram Handle

@hairbykaesha

4

What can I help you with?

Specifically lowering toxins in my home

Swapping essential items at the click of a button

Changing no routines except less time in the stores, more money in your pocket and less toxins in your body

All of the above

5

Do you understand that Melaleuca has a 90 day money back guarantee?* This field is required.If for any reason you are unsatisfied with your products, simply call customer service for your full money back, store credit or product exchange!

YESNO

6

Do you understand that you are in complete control of your account and can cancel your membership FREE at anytime?You can also restart it anytime too!

YESNO

7

DO NOT ACTIVATE THE SHOPPING REFERRAL LINK YOU RECEIVE FROM ME UNTIL YOU ARE READY TO ORDER!You will receive a $20 USD/ $24 CDN credit (loyalty dollars) that will be applied to your first order (above the 35 point minimum but you must order within 30 days of activation! You get your membership fee back on your first purchase so it’s basically FREE! Do you understand you have to order within 30 days of activation?

YESNO

8

Are you interested in making extra money and earning extra perks through the Wellness store?

Please send me more info on this as well

Potentially after I use the products

Yes I am definitely interested

No thanks I just want to shop the products