Tahitian Noni International, Inc. 
DISTRIBUTOR APPLICATION AND AGREEMENT

"TAHITIAN NONI®, Morinda®, Tahiti Trim®, Expressway™, and Tahiti Dream® 
are registered trademarked terms of Tahitian Noni International, Inc.

For all international countries click here

You can use the form below or use your telephone to sign up as a Tahitian Noni International distributor under Gary Ryan (distributor no. 6021 ) A Double Diamond Pearl. 

If you have trouble or are enrolling internationally go to: The corporate enrollment page.

To Enroll in Canada Click Here

To Enroll in Mexico Click Here


Be sure to completely fill out all sections before you submit the form. Call me if you have questions. Gary Ryan 1-800-995-7434 or 1-626-354-0578 U.S. Telephone. The Fax number is 1-800-995-7434

APPLICANT INFORMATION: Read the disclosure before enrolling.

Type of Applicant Individual Company

Company Information (if applicable) ssn also required for company applicants. ceo ssn Company Name Federal I.D. number or SIN number (SSN Also required for company applicants)

Applicant Information (or contact information if applicant is a company) Mr. Ms.   First Name Last Name Home Phone (Include Area Code) Business Phone (Include Area Code) Fax (Include Area Code) PCMac E-mail address (required) Computer Type / Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / Birthdate (Day/Month/Year) (required for individual applicants only) Social Security Number (required for individual applicants only)

Co-Applicant Information Mr. Ms.   First Name Last Name       Social Security Number

Mailing Address Street City State/Province Zip/Postal Code

Shipping Address (if different from mailing address) Street City State/Province Zip/Postal Code

Other Information, Comments, or Instructions

AUTOSHIP PROGRAM INFORMATION (review how it works...)

Autoship Sign-up Information I want Autoship to start as soon as this application is received and approved. I do not wish to start the Autoship program at this  time. In subsequent months, ship in the same (as initial) first second third fourth last week of the month.

Autoship Quantity Information Please send me case(s) each month of TAHITIAN NONI® Juice at Wholesale. (suggested retail is $160 per case) 4 Bottles Included) Wholesale is ?? percent less. case(s) each month of Equine Essentials™  (suggested retail $159.50 Retail for 2 bottles) Send my Autoship even if I've made other orders during the month. Don't send my Autoship if I've made other orders during the month that meet or exceed my monthly agreement. Option Autoship Plan

Autoship Payment Information Method of payment: Credit Card Automatic Check Draw (please contact us at this address) for other payment options. Visa Master Card Discover Card Same as starter kit Card Type Card Number Billing Zip/Postal Code (required) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Expiration Date Name on Card

 NETWORK WEB PROGRAM INFORMATION

Network Web Signup (review how it works) I want a $25.00 Network Web (the URL would be similar to mine at: http://www.tni.com/buynoni) $25.00 per month to keep site up to date and $25.00 initial set up fee.   I do not want a web site at this time   Press the start button when finished and you will become a new Tahitian Noni International Independent Distributor!