REGISTRATION FORM - “AREIVIM USA” PROGRAM | PDF














Husband feels well, does not have any significant medical issues and has no history or suspicion of significant medical issues.
Wife feels well, does not have any significant medical issues and has no history or suspicion of significant medical issues.
If you have any questions about this provision, please contact our office.


Our office will contract you for full payment information.
I also hereby authorize Areivim USA to charge my account for up to $28 on the above specified date of each month as per terms and conditions. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Areivim USA in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next charge date. If the above noted payment dates falls on a weekend or holiday, I understand that the payments may be executed on the next business day.

By clicking submit, I confirm that I have read and agree to the Terms and Conditions of Areivim USA.


ACCEPTANCE TO THE PROGRAM IS CONFIRMED ONLY UPON MEMBERS RECEIPT OF A WRITTEN CONFIRMATION.


For more information please contact us: office@areivim.info
or by phone 1-866-727-3484.