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  Member Enrollment
Enroll A New Member
Build your business! You may enroll new members here by entering their personal information and placing their enrollment order. By continuing to build your business, you are ensuring your success as you climb your way to the top! Enrolling is simple and easy. Just fill out this form and we will take care of the rest!
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Tell Us About Yourself
   
Please Enter Your Personal Information
Begin your enrollment here by entering your name and address, along with your shipping information. For tax reporting purposes, you will also be prompted to enter your social security number or EIN. All required fields are indicated by ●
  Referred By
Name ●
 
  Company Name
  Shipping Address
  Address ●
   
  Country ●
  City ●
  State ●
  Zip ●
  Contact Information
  Phone
  Email ●
  Birthdate
  Identification
  SSN/EIN ●
 
 
 
 
     
Select Your Enrollment
 
Enrolling as an Associate
Make a selection from the drop-down below.
  Product
 
Select a product in the list above. A description and image of the product will then appear in this area.
 
 
 
     
Automatic Shipment Setup
 
Make your selections for monthly shipment
Make your automatic shipment selections here. Ship date and product selection can be managed in virtual office upon successful sign-up. Payment not required during enrollment.
 
Autoship
Choose from Lash & Brow, R&R Super Serum, or Renew Super Pack for your Monthly Autoship
 
     
Enter Payment Information
 
Select A Payment Method
Enter your payment method below. Once this form is completed, you will be on your way to building a new and exciting business! Please note that totals do not include Auto-Ship selection from above.
 
Order Totals
Product Sub-Total $ 0.00
Discount Applied $ 0.00
Shipping and Handling $ 0.00
Country Specific Fees $ 0.00
Sales Tax $ 0.00
Gift Certificates Applied $ 0.00
Total Amount Due $ 0.00
 
Select A Shipment Method
Shipping Method
 
Have a Coupon? Apply it here
Enter Coupon Code
   
 
Apply Your Gift Certificates Here
Search by Serial Number  
 
 
Payment Method
 
Billing Address (must match credit card)
 
Name
 
Address
 
Country
City
State
Zip
     
Set up your Replicated Website
 
Select your website name and password
A Replicating website is an important part of your business. Choose a name that will be easy to remember! Your website name must be unique in our system and must not contain any spaces or special characters. An example of a correct website name is as follows:

http://YOURWEBSITENAMEHERE.veribella.com
 
Website Name
   
Enter A Password For Your Web Office
Password
Confirm
   
 
     
Complete Your Order
 
Final Confirmation
You are almost done! By clicking on the button below, your order will be processed and your enrollment will be completed.  You will receive an email confirmation shortly with details of your order.
 
Terms And Conditions
Please click on the Download link below and read the terms and conditions document. Once you understand and agree to the terms outlined in this document, select the 'I Agree to the terms and conditions' checkbox below to continue.
Click Here To View Terms and Conditions