Please call 877.GO.XANGO (469.2646) or
fax this form to 801.816.8159
All fields must be filled out completely
last name (please print)
middle initial
alt. phone
postal code
sponsor ID#
placement** ID#
*SSN is only required for U.S. Distributor sign-up
**Placement does not apply to Customer sign-up
Independent Distributor ($35 fee)*
“I want to start my own home-based business!”
Purchase XANGO/XALO products at wholesale prices
30-day 100% money-back guarantee
Participate in XANGO/XALO Automatic Delivery Program (ADP)
Participate in XANGO/XALO compensation plan
Preferred Customer ($5 fee)*
“I just want to consume the products.
I’m not interested in the opportunity right now”
Purchase XANGO/XALO products at wholesale prices
30-day 100% money-back guarantee
* Fee waived through January 31, 2014
* Fee waived through January 31, 2014
• XANGO Juice
• XALO Ageless (Special pricing - SAVE $5)
Initial Order
Step 1: Initial Order (100PV required for FREE Customer or Distributor sign-up)
Step 2: ADP Order (200 PV required for FREE Distributor signup)
• ADP Qualifier 200 (Juice + XALO )
Includes one case of XANGO Juice and one box of XALO Ageless
(120PV XANGO & 100PV XALO)
• ADP Qualifier 200 (Juice + XALO Pro)
• ADP Qualifier 400 (Juice + XALO)
Includes one case of XANGO Juice and one box of XALO Pro 100 Pack*
(120PV XANGO & 100PV XALO)
Includes two cases of XANGO Juice and two boxes of XALO Ageless
(220PV XANGO & 200PV XALO) Save $40!
• ADP Qualifier 400 (Basics + XALO + Pro)
Includes Healthy Basics**, XALO Pro 100 Pack* and XALO Ageless
(200PV XANGO & 200PV XALO) Save $42!
*XALO Pro 100 Pack: Limitless Citrus x 2, Ignite, Reload
**Healthy Basics: XANGO Juice, Eleviv, 3SIXTY5
NOTE: Sales tax will be added where applicable. UPS shipping
Payment Option: (check one)
credit card #
name (as shown on card)
expiration date (mm/yy)
credit card billing address (street, city, state, zip)
signature of cardholder
date (mm/dd/yyyy)
By signing here, I authorize XANGO to process my order, charge my credit card referenced above for my Initial Order and my Monthly ADP Order as specified under
the Order Information section of this form. If I check the “Preferred Customer” box, I understand that I am subject to the terms and conditions 1–17 (see reverse).
If I check the “Independent Distributor” box, I understand that I am applying to become a Distributor representative of the Company, and I agree to all the Terms
and Conditions below, the Policies and Procedures, and all other terms of the Contract, all of which are incorporated herein by this reference and are found at I am familiar with the return policies described in the Policies and Procedures found at
Signature: Date:
I agree to the terms and conditions stated below (“Terms and Conditions”):
1 | Purchases: I may only purchase Company products from XANGO, LLC located at 2889 Ashton Blvd. Lehi, Utah 84043 USA or any lawful assignee, successor, subsidiary, or affiliate
(the “Company”).
2 | Automatic Delivery Program (“ADP”): I may choose to have Company products sent to me monthly on an automatically processed order. To change or cancel any detail pertaining
to my ADP order, the request must be received by the Company (not an Upline Distributor) in writing, signed by me. All orders are subject to the applicable Value Added Tax (VAT)
or Goods and Services Tax (GST) of my region, which will be added to the order total. Shipping & handling charges will also be added. The credit card or bank draft listed on the
account will automatically be charged for this order. Orders with declined bank drafts, or orders with declined or expired credit cards may not be processed. Attempts may be made
by the Company to reprocess the order should a credit card decline; however, the Company makes no assurances that these attempts will be made. If a credit card is due to expire,
a notice may be printed on the ADP invoice prior to expiration; however, I am responsible for providing current payment. If I elect direct debit for my ADP orders, the Company
is hereby authorized and may debit my account for orders shipped on or after the date of payment and I agree to maintain sufficient funds in my account to cover the automatic
payments. In the event sufficient funds are not in my account to cover the automatic payment, the Company may stop shipment en route, and may refuse to accept further orders
with this payment method. Attempts may be made by the Company to reprocess the order; however, the Company makes no assurances that these attempts will be made. I shall
indemnify and hold the Company harmless from any and all liability which may arise out of the Company’s initiating an authorized debit to my account, except the liability to ship
the product as ordered.
3 | Returns, Refunds and Exchanges: If I am not completely satisfied, I may return current Company product within thirty (30) days from the date of order for any reason and the
Company will refund the purchase price less shipping and handling charges. After thirty (30) days and prior to ninety (90) days I may return current Company product and the
Company will refund the purchase price less a 10% restocking fee, provided that all other requirements listed below are met. To make a Product return, I must contact the Company’s customer support. All returns require a return merchandise authorization (RMA) number prior to shipment. Product shipped without an RMA displayed on the outside of the
shipping carton will be refused. Upon receipt of the returned Product, the return will be noted by the Company and a refund will be issued to me within thirty (30) days. Refund
payment methods are limited to the original form of payment, or if not available, by check in US dollars or such other form as the Company may choose. No refunds will be issued
after one year from the purchase date. All refunds are subject to: (a) the request for a refund being made within ninety (90) days of purchase; (b) the product being returned in
a marketable condition (unopened, unaltered and resalable) as determined by the Company; (c) the product being sent through a form of delivery that can be traced (e.g., UPS)
and received within seven (7) days of contacting the Company. All shipping or courier costs for the return of product will be borne solely by me unless otherwise prohibited by
law. Any damage or loss that occurs to the returned product during shipping will be my responsibility. Should the product arrive at the Company damaged (thereby rendering it
non-resalable), the Company will reject the shipment. The Company will exchange product if the product is damaged in shipment, incorrectly sent due to a Company error, or of
substandard quality. However, when an exchange is not feasible, the Company will refund the amount of the returned product. If product is damaged or defective, I should contact
the Company within ten (10) days of receipt of the order. The Company will issue a call tag for the product and immediately send a replacement order. The Company will inspect
the product upon receipt.
4 | Authorization for Purchases: In the event I choose to purchase Company products on my credit card or banking debit card, my signature on this order form hereby constitutes my
authorization to process any order I place to those accounts, and is to be used as my “signature on file.” All shipping and handling charges incurred will be billed. I understand that
I may cancel my order, without any penalty or obligation, within thirty (30) business days of the placement of a particular order by giving written notice to the Company bearing
my original signature, printed name, address and Customer or Distributor ID number.
5 | Privacy of Information: All information provided by me on this form will be used solely for the purposes of evaluating this application and for my related activities. I authorize the
Company to disclose, in the Company’s sole discretion and only for purposes of the Distributor Business, my contact information to the applicable Distributor’s Upline, and to the
applicable Distributor’s Downline Organization three (3) levels below (as such terms are defined herein).
6 | Notices: All written notices to the Company should be delivered to:
P.O. Box 900
Lehi, UT 84043 U.S.A.
7 | Miscellaneous: The Company reserves the right to make any modifications to these Terms and Conditions, provided that the modifications are communicated by the Company
to me at least thirty (30) days prior to taking effect. The Company may communicate these modifications by posting any portion of the modified Terms and Conditions on the
Company’s country specific website indicated in Specific Country Requirement ii, or by any other method of communication. I am deemed to have accepted the modification to
the Terms and Conditions if I accept delivery of any orders of Company products after the thirty (30) day period is ended. The Company may terminate this agreement if I violate
theses Terms and Conditions or any modification thereof.
8 | Entire Agreement: These Terms and Conditions contain the entire understanding concerning the subject matter hereof between the Company and me, and is intended as a final,
complete, and exclusive expression of the terms of the parties. These Terms and Conditions supersede and replace all prior negotiations and proposed, but unexecuted agreements, either written or oral. Any prior agreements, promises, negotiations, or representations, either written or oral, relating to the subject matter of these Terms and Conditions, are of no force or effect. If there is any discrepancy between verbal representations made to me by any employee or agent of the Company and these Terms and Conditions,
the express written terms and requirements of the Terms and Conditions will prevail.
9 | Warranties: Except to the extent required by local law, the Company extends no product warranties, either expressed or implied, beyond those specifically articulate. The
Company disclaims and excludes all warranties regarding possible infringement of any United States or foreign patent, trademark, trade name, copyright, or trade secret arising
10 | Waiver: Any waiver by the Company of a breach of any provision of these Terms and Conditions must be in writing and will not be construed as a waiver of any subsequent or additional breach committed by me. The failure by the Company to exercise any right or privilege under the Terms and Conditions will not constitute a waiver of that right or privilege.
11 | Severability: If any term or condition of these Terms and Conditions is judicially invalidated, prohibited, or otherwise rendered unenforceable in any jurisdiction, it is unenforceable only to the extent of the invalid, prohibited or unenforceable provision in that jurisdiction only, and it will not render unenforceable or invalidate any other provision of the
Terms and Conditions, nor will they be rendered unenforceable or invalidated in another jurisdiction. Furthermore, any provision found unenforceable may be partly enforced to
the maximum extent enforceable under the law.
12 | Attorneys’ Fees: If any suit, action, or proceeding is brought to enforce any term or provision of these Terms and Conditions, the prevailing party shall be entitled to recover
reasonable attorneys’ fees, costs, and expenses incurred, in addition to any other relief to which such party may be legally entitled.
13 | Successors and Assigns: The Terms and Conditions will be legal and binding upon and inure to the benefit of the heirs, devisees, executors, administrators, personal representatives, successors, and assigns (as applicable) of the respective parties hereto.
14 | Force Majeure: The parties are not liable for any damages or losses caused by the delay or inability to perform the obligations provided for herein due to labor strikes, accidents,
fire, flood, acts of civil authority, acts of God, acts of terrorists, or from any other causes that are beyond the control of the respective party.
15 | Limitation of Liability: To the extent permitted by law, the Company, its directors, officers, members, managers, shareholders, employees, assigns and agents (collectively referred to as “Responsible Parties”) shall not be liable for, and I hereby release Company and its Responsible Parties from and waive all claims, for any loss of profits, indirect, direct,
special or consequential damages, and for any other losses incurred or suffered by me as a result of: (i) my breach of these Terms and Conditions; or (ii) incorrect or wrong data
or information provided by me to the Company or its Responsible Parties. I AGREE THAT THE ENTIRE LIABILITY OF THE COMPANY AND ITS RESPONSIBLE PARTIES FOR ANY CLAIM
16 | Governing Law and Language: All matters relating to the interpretation, construction, validity and enforcement of these Terms and Conditions and the relationship of the parties
shall be governed by the internal laws of the State of Utah, USA without giving effect to any choice of law provisions thereof. The English language version of these Terms and
Conditions shall govern.
17 | Definitions: Each of the following words and expressions as used throughout the Agreement shall have the meaning as stated below:
• “ADP” An optional program that authorises the Company to automatically ship products to a Customer or a Distributor on a recurring monthly basis;
• “Compensation Plan” The specific plan used by the Company that details the requirements and benefits of the compensation structure for Distributors.
• “Customer” A non-Distributor who purchases products at the suggested retail price, who agrees to purchase Company products only for personal use, and who is not entitled
to the commission benefits of the Company’s Compensation Plan.
• “Distributor” A person currently authorized by the Company to operate a Distributorship.
• “Distributor Business” Activities determined at the sole discretion of the Company to be a promotion of the Company’s products or business opportunity.
• “Distributorship” A defined position within the Company’s network of Distributors.
• “Downline” The single-line hierarchy of Sponsors and/or Distributors extending downward from a Distributorship.
• “Sponsor” A Distributor who has directly recruited a Customer or another Distributor into his or her Downline Organization.
• “Upline” The single-line hierarchy of Sponsors and/or Distributors extending upward from a Distributorship.
Initials of Preferred Customer: I have reviewed the provisions herein and understand that I will be subject to the above terms and conditions. I choose not to be a
Distributor and I agree that to buy company products for personal use only. I understand that I am not entitled to commission payments, but that the commission benefits of my
purchases go to the applicable Distributors under the Company’s Compensation Plan.
The following Paragraphs 18 to 33 Apply to Distributors Only:
18 | I am legally competent to enter into this distributor agreement (the “Distributor Agreement”) in the jurisdiction in which I reside. I further understand that I am contracting with
XANGO, LLC (“XANGO”) for the promotion of certain sales as described below. I understand that I am also contracting with XANGO Disc, Inc. (“XANGO Disc”) for the promotion of
certain sales as described below. Hereinafter, XANGO and XANGO Disc may be referred to collectively as the “Company.” Unless otherwise defined herein, all capitalized terms shall
have the same meaning assigned to such terms in XANGO’s Policies and Procedures. The term “Contract” shall mean the Distributor Agreement, the Statement of Beneficial Interest, the Compensation Plan, the Policies and Procedures and any country or situation-specific addendum(s) thereto, and any other written agreement between the Distributor and
XANGO. I hereby agree to be bound by the Contract which may be amended from time to time.
19 | I will become a Distributor upon acceptance of this Distributor Agreement by the Company, and I will, at that time, have the right to purchase Products at wholesale from the
Company or its affiliates.
20 | I understand that no purchase is necessary to become a Distributor other than a $35USD distributor kit fee. A $20USD annual renewal and materials fee is required to maintain a Distributorship. While the Company may charge the available payment option (at the time of renewal), I am responsible for renewing my Distributorship each year. I expressly authorize XANGO to
collect the annual renewal and materials fee using any payment method on file for the purchase of Product.
21 | The $35USD distributor kit fee to become a Distributor is non-refundable, except as otherwise provided in the Contract. Renewal and materials fees are also non-refundable.
22 | If I wish to terminate this Distributor Agreement, I will submit to the Company written notification of my intent to terminate. Such notice will also automatically terminate my
Contract with any affiliate of the Company. My voluntary termination will be effective as of the date such notice is accepted by the Company. A Distributor may terminate at any
time for any reason.
23 | As a Distributor, I am an independent contractor and not an employee, partner, agent, franchisee, or legal representative of the Company or any affiliate. I agree that I am solely
responsible for my compliance with any laws or regulations related to my status in any jurisdiction exercising authority over me, including but not limited to, compliance with
applicable regulations and the Contract.
24 | Although the Company may assist me in becoming aware of applicable laws, rules, and requirements, the sole responsibility to conduct my Distributorship lawfully in any jurisdiction rests with me. Therefore, I release the Company and its officers, directors, agents, advisors and employees from all liability for my conduct, actions, or omissions. I also waive
any claims or causes of action which I (or others acting in my interest) may have occasion to assert respecting my status or conduct as a Distributor, arising out of any of my acts
or omissions.
25 | I understand that only Distributors who are in compliance with the Contract may act as sponsors. The Company, in its sole discretion, may reject this Distributor Agreement without disclosing any reason therefore. If this Distributor Agreement is not accepted or approved, I release the Company and any affiliated entity and their officers, directors, agents,
advisors, and employees from any and all liability incurred by me or by any other person. I waive any associated claim(s) that might be asserted in my interest.
26 | I understand that Commissions from the Company are earned through my participation in the Compensation Plan. I am entitled to receive Distributor benefits and opportunities
offered to Distributors through the Compensation Plan, provided I maintain a Distributorship that operates in compliance with the Contract. I hereby acknowledge that I have
access to all documents comprising the Contract, the contents of which are incorporated herein by reference. The Compensation Plan and its commissions, overrides and/or bonuses, relating to the sale or other output derived from personal sales, solicitations or orders from customers, are privileges of my status as an active Distributor in good standing.
I agree to abide by the Contract, as modified from time to time, and posted at
27 | XANGO has the responsibility to promote the sale of Products within the United States. To the extent that commissionable sales occur where Products are delivered for distribution inside the United States or its territories, Commissions on those sales, under the Compensation Plan, will be the legal responsibility of, and will be paid by, XANGO.
28 | XANGO DISC, a XANGO affiliated entity, has the responsibility to promote the sale of Products internationally. To the extent that commissionable sales occur where Products are
delivered for distribution outside of the United States or its territories, commissions on those sales, under the Compensation Plan, will be the legal responsibility of, and will be
paid by, XANGO DISC. Nevertheless, for administrative convenience, Commissions paid under the Compensation Plan generally should be issued on a single check or similar instrument or transaction, combining, for the convenience of the Distributor, the Commissions earned by both U.S. and non-U.S. sales.
29 | I understand that as a Distributor, I am authorized to sell Products. I agree that I may not alter, repackage, re-label or otherwise change any Product, nor will I sell any such Product under any other name.
30 | I understand and agree that I may not convey, assign, or otherwise transfer any rights arising hereunder without the prior express written consent of the Company.
31 | I agree that I may not create or hold a Beneficial Interest in additional Distributorship(s), beyond the indirect benefits that are derived from sponsoring and Downline volume.
32 | I certify the accuracy of all information provided by me in this Distributor Agreement and agree that the providing of false or misleading information authorizes the Company, at
its election, to declare this Distributor Agreement void from its inception.
33 | The Company agrees to provide quality Products, so long as I comply with the Contract. I agree that invoices may be sent to me electronically.
I understand that Commission benefits of my purchases and Personal Volume (as defined in the Compensation Plan) go to the sponsor/placement listed on this form and other
Distributors under the rules of the Compensation Plan.
The Company reserves the right to terminate the relationship should the Distributor breach the terms of the Contract.
Initials of Distributor: I have reviewed the provisions herein and understand that I will be subject to the above terms and conditions.