No:

Nome: ___________________________________________________

Conjugue, filhos:_______________________________
______________________________________________
Data nascimento __/__/_____ ______________________________________________
Tel dia ________________________noite ____________________________ ______________________________________________
Cel __________________e-mail __________________________________
Cidade ______________________ Estado:__________
Endereo_____________________________________________________
Bairro_________________________________________
cep_____________________
Hbitos comida, bebida, __________________________________________ ______________________________________________
_
Motivo de usar produtos __________________________________________ ______________________________________________
_
Problema especial:
Altura _______ peso ______ peso desejado:_______
Dia Data Peso
Busto Cintura
Barriga
Quadril Total Obs :__________________________________________
cm
1
3
7
14
21
28
40
60
70
80
90
100
120
140
160
180

Antes

Depois

___ kg para perder

programa _____+_____
produtos para perder: __________________________________________________
produtos para manter :__________________________________________________
valor total:___________ forma de pagamento: ______________________________
Produtos
Vendido
P de Bebida
Fiber & Herbs
Programa A
Thermojetics 100g

Programa B
Cell-u-loss
Programa C
NRG - P
NRG - Tab
Thermo Sabor
Protena de
Soja
Multivitaminico
Xtra-Cal
Fiberbond
Ass.

Item de promoo
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____

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Cartas:________________________________________________________________________________
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obs.__________________________________________________________________________________
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