Distributor Credit Redemption Please complete the form below if you would like to receive a Distributor Credit for your Rewards Points. Column Content Name First Last Company Member ID# Business Address Address Address 2 City/Town State/Province State/ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingOntarioQuebecNova ScotiaNew BrunswickManitobaBritish ColumbiaPrince Edward IslandSaskatchewanAlbertaNewfoundland and Labrador ZIP/Postal Code Country - None -United StatesCanada Business Phone Cell Phone Email Distributor Name Distributor Name - Select -Other… Enter other… Distributor Address Your Account # With Distributor Number of Rewards Points to Redeem I certify that I am authorized to make this request on behalf of my company Leave this field blank