Casa Friends Nordic Royalty Deduction Form

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Question - Not Required - Date of Birth *Optional




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Question - Required - I would like to:

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Question - Required - I would like to pay with a deduction from my Herbalife Nutrition:

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Question - Required - Check type:

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My donation must conform to all local laws and regulations. My donation may or may not be tax deductible. Because of local currency restrictions and laws, some countries are excluded from this method of donation. All amounts indicated herein are in U.S. dollars. Herbalife International is an international corporation, and as such maintains foreign exchange rates in house which it will use when donations to Herbalife Nutrition Foundation are calculated under Payment Option 2 above to remain consistent with Herbalife accounting systems. If royalty earnings for any given deduction are not sufficient to support the full deduction, no funds will be taken from that check. Donation deduction will carry forward until the pledge is paid in full. If it is not possible to deduct funds from your royalty check, HNF staff will be in contact to arrange for an alternative payment method. Herbalife Nutrition Foundation reserves the right to terminate this agreement at its discretion at any time. Contributor may cancel the automatic contribution by submitting a written cancellation directly to the Foundation. This request must be received by the Foundation two weeks prior to check processing. Once the donation has been processed, absolutely no refunding of the money contributed will occur.
By submitting this form, I understand and accept the above terms.
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