ORDER FORM

OlyLife

New Member Intake Form

Please complete this form carefully.
All information must match your government-issued ID exactly.

Personal Information

Legal First Name (As shown on ID) *

Legal Middle Name(If applicable)

Legal Last Name (As shown on ID) *

Government ID Number (Driver’s License, Passport, or National ID) *

⚠️ The name and ID number must match exactly to avoid account verification delays.

Gender *

Contact Information

Email *

Phone *

Primary Address where order will ship

Street Address *

City *

State *

Country *

Postal Code *

Alternate Recipient Information (Optional)

Only complete this section if products will be shipped to someone else.

Recipient Name

Recipient Phone Number

Recipient Full Address

Recipient Postal Code

Recipient Country

Who Referred You?

If no sponsor please check this

I do not have a Sponsor/Referral

Sponsor Name *

Sponsor Email *

Are you in any of Pace's communities? *

Yes

Which best describes your interest right now? *

Product Selection (See Products Page)

Enter quantity for each product.

Kindly enter the quantity for each product. If unsure, enter 0 and we’ll follow up.

OlyLife THZ Tera-P90+ *

$1,500 (per unit) + 10% Shipping & Handling

OlyLife Shaken Massager *

$1,000 (per unit) + 10% Shipping & Handling

OlyLife Galaxy G-One *

$500 (per unit) + 10% Shipping & Handling

OlyLife Vitality Wand *

$600 (per unit) + 10% Shipping & Handling

OlyLife A9 Smart Anion BamaAir *

$500 (per unit) + 10% Shipping & Handling

OlyLife H+ Bar *

$600 (per unit) + 10% Shipping & Handling

OlyLife Skyline SL-6 *

$500 (per unit) + 10% Shipping & Handling

Frost Age Gel *

$500 (per unit) + 10% Shipping & Handling

Important Acknowledgment

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

I understand that once I submit this intake form, my account will be manually entered, and I must be ready to submit payment immediately once payment instructions are sent. If I am not ready to submit payment yet, I understand that I should wait to submit this form until I am ready.

ORDER FORM

OlyLife

New Member Intake Form

Please complete this form carefully. All information must match your government-issued ID exactly.

Personal Information

Contact Information

Primary Address where order will ship

Alternate Recipient Information (Optional)

Who Referred You?

Product Selection (See Products Page)

Important Acknowledgment

Please complete this form carefully.
All information must match your government-issued ID exactly.