Sandra Tillinghast's White Eagle Success Site

S k i n C a r e Q u e s t i o n n a i r e

Fill out this form completely and receive
a catalog and a week's worth of FREE samples.

ONE SAMPLE REQUEST PER PERSON

Alpha Hydroxy Acids (apple, citrus, green tea and sugar cane) along with Vitamins A, C and E (free radical fighting antioxidants) help to soften, repair and protect the skin while insulating it from premature aging.

1	Are you currently on a skin care regimen?	YES		NO

2	What products do you use?

3	Are you currently having chemical peels or using alpha hydroxy products?	YES		NO

4	Have you ever used Retin-A?	YES		NO

5	Are you aware that AHA’s give the same results as Retin-A with less irritation and can be used long term and consistently?	YES		NO

6	What is your skin type?	Normal		Combination/Oily		Dry

7	Would you be interested in ridding sunspots from your face and body?	YES		NO

8	Would you be interested in products that will improve the elasticity and softness of your skin?	YES		NO

9	What would you like to improve about your skin?

10	Are you currently reading labels on products and making sure what you use is not only effective but also safe?	YES		NO

11	Would you be interested in receiving samples of Arbonne’s advanced skin care products?	YES		NO

12	Would you be interested in having a home-based business that you could work part-time or full-time and make an extra $300, $1500 or higher each month?	YES		NO

13	Is spending more time doing the things you want to do and creating a lifestyle that supports your choices important to you?	YES		NO

14	Do you tell other people about the things that you try and like; movies, restaurants, stores, books, etc.?	YES		NO

Name

Address

City

State

Zip

Country

Would you like to sign up for my E-Newsletter? …which includes tips and information on anti aging, skin care, health and beauty. It also includes information on new Arbonne products, specials and discounts throughout the year. Unsubscribe anytime.

Telephone
(Your valid phone number is required to prevent abuse)

E-Mail Address (please enter carefully)

Questions? Comments?

The information you submit here
will not be disclosed to third parties.

For more information call
Sandra Tillinghast
Independent National Vice President
(888) 895-4383 toll free