Account Info
First Order
Total: Rm0.00 / 0 LP
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Payment

Account Information

Contact Information

  • First Name First Name is required
    Last Name Last name is required
  • Email Valid email address is required
    Did you mean $suggestion$?
    Phone Phone is required
  • Choose Password Password must be at least 4 characters in length.
    Confirm Password Make sure the passwords match
  • MyKad
    Social Security Number is required
    Language Language is required

Enroller/Sponsor Information

  • Enroller ID Number Enroller is required
    Or

Billing Address

  • Address is required
    Billing Address Line 2 is required.
  • City is required
    Billing State is required
  • Zip code is required
    Country is required

Shipping Address

  • Name Name is required
  • Address Address is required
    Address Line 2 Shipping Address Line 2 is required
  • City City is required
    State State is required
  • Zip Code Zip code is required
    Country Country is required

Agreement

  • By checking this box, I acknowledge that I have read 4Life's Terms and Conditions.
    Electronic consent is required
  • By checking this box, I acknowledge that I have read 4Life's Privacy Policy. I understand and agree to be bound by the terms of 4Life's Policies & Procedures.
    By checking this box, I agree that my online sign-up will only become effective within three [3] working days after I have purchased the Distributor Kit.
    I also agree that if I fail to purchase the Distributor Kit within thirty [30] days from the date of my online sign-up, my sign-up will not become effective and shall lapse.
    I will also send or deliver the original signed hard-copy of the Distributor Agreement to the Company within thirty [30] days from the date of my online sign-up.
    Policies and Procedures are required
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