Zija International Pre-Enrollment - India

Please complete this form in full to secure your place as we work toward launching Zija International in India!

New Enrollee Information

Name *
Date of Birth *
Date of Birth
Phone *
Address *
Sponsor Information
Sponsor Name *
Sponsor Name
Sponsor Phone *
Sponsor Phone
Cost of initial purchase into the business is to be confirmed by Zija International Corporate, but shall be no more than:
Zija Rewards Purchase is a program of convenience that automatically charges and ships the products of your choice approximately every 4 weeks after the Initial Order. For more information regarding the Zija Rewards Program see the full Zija Compensation Plan. The cost of Zija Rewards Purchase (Repurchase) is to be confirmed by Zija International Corporate, but shall be no more than:
Payment Information
OR - Elect to pay by cash and provide number of photo ID, to be verified at time of enrollment:
Enrollment Fee/Payment *
The Enrollment Fee to become a Zija Distributor is waived with the purchase of any Zija Business System (to be advised by Zija International Corporate). I understand that a yearly renewal fee is required to continue as a Distributor. I authorize Zija to charge the annual renewal fee via my preferred payment method as it becomes due. I understand a renewal fee is applicable annually, starting thirty (30) days prior to my enrollment anniversary date to maintain my Distributor status.
Terms and Conditions *
By entering my name below as an electronic signature, I have read, understand and agree to abide by the Zija Policies & Procedures / Terms and Conditions, and that this enrollment form is abbreviated and not intended as a substitute for full disclosure of the Zija Policies & Procedures / Terms and Conditions. I understand that a complete disclosure of such documentation is available upon by request. I authorize my enrolling Sponsor to process the initial order with the information I have supplied herewith. In addition, I authorize Zija to process my order and to charge my credit card referenced above. PLEASE NOTE THAT NOTHING WILL BE CHARGE TO THE ENROLLEE'S NOMINATED PAYMENT METHOD UNTIL ZIJA CORPORATE HAS ADVISED PRODUCT SELECTIONS, PRICING AND AVAILABILITY FOR SHIPMENT, AND ENROLLEE HAS CONFIRMED ACCEPTANCE.