FREE samples!

This questionnaire will help me know the best products to recommend for you. Please be as honest and thorough as you can for me to give you the best analysis. You'll then receive an email with the link to request your free samples directly from the company.

Please allow up to 3 weeks for delivery of sample(s).

Be sure and "friend" me on Facebook- I can invite you to our Feel Good Party with weekly prizes where you'll learn more about the products and what they can do for you! Dawn Davis Vaughan

Full Name *

First Name Last Name

E-mail: *

Mailing Address to receive samples

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Mobile Phone Number

Area Code Phone Number

How did you find me?

Are you currently a Plexus *

Customer Preferred Customer Ambassador None of the above

Which sample would you like? *

Plexus Slim Microbiome Activating drink packet (for gut health) Plexus Slim Hunger Control drink packet Active nutritious energy drink packet Lean meal replacement shake powder (milk chocolate)

If you'd like to purchase a 3 Day Weight Loss Challenge Box containing all 4 of our best weight loss products, I can invoice you on Paypal. $20 US with free shipping. You can pay with any major credit card, debit card or Paypal balance. *

Yes, please No thank you Maybe later

Height

Weight

Desired Weight Goal

If you feel you are overweight - When or How did you gain your weight?

I put on a little weight at a time, over a long period of time. I have had excess weight for a long period of time. I put on weight in a 'short period of time' or during an event - such as: on hormones, steroids, during pregnancy, during a stressful time, etc.

Do you have sugar level issues? (or family history) *

Yes No No, but family history of

Do you have high cholesterol? *

Yes No No, but family history of

Do you have high blood pressure? *

Yes No No, but family history of

Do you have any heart problems? *

Yes No No, but family history of

How much water (in ounces) do you drink a day? *

Do you crave or consume any of these? *

Sugar/sweets Carbs Sodas Diet Sodas Artificial sweeteners Bread/pastries None

Do you have any digestive disorders? *

Yes No Sometimes

Do you know what the term "gut health" means? *

Yes No Not sure

Do you have any health problems?

On a scale of 1-5 (1 being you're not interested at all, and 5 being you're ready to order or join today) where are you? *

	1	2	3	4	5

1 is Worst, 5 is Best

If I could show you a way to get your product for free, would you be interested? *

Absolutely Not at this time Possibly... what would I have to do?

Do you agree to try the sample as soon as you receive it? I will contact you within a week of mailing it to see how you like it :) *

Yes No

Would you like an invitation to my private Facebook Feel Good Party group with weekly prizes? *

Yes, please! No, thank you

Would you like info on how you could earn money using the website you receive when you join? *

Absolutely Possibly Not right now, the timing is not right for me

Request a FREE sample of our product-- one request per household, please!