Profile Assessment and Questionnaire

"You are what you eat, so !"

*NEW CUSTOMERS- To get started, please complete your weight loss and nutrition assessment below. It is important for us to understand your specific needs and which of our meals plans will work best for you.

We respect your privacy, and promise to keep all the information you share confidential.

Name:

First:  
Last:  

Your Current Activity Level:

*EXAMPLES: Sedentary = Spends most days sitting, occasional physical activity.

Moderately Active = At least 30 minutes, three times a week of moderate intensity physical activity.

Very Active / Athletic = 60-90 minutes, 5-7 days a week of moderately intense physical activity.

Activity Level:

Sedentary
Moderately Active
Very Active / Athletic

Body Fat Calculator:

Medical Conditions:

Allergies:

Food Dislikes:

Chose one of the following meal plans:

Mediterrannean  Paleo  Vegetarian 

Number of Days:

Five  Six  Seven 


Body Type:

Male
Female
Active
Pregnant
Nursing
N/A

Age:

Height (In Inches):

CURRENT WEIGHT IN LBS:

GOAL WEIGHT IN LBS:

Body Frame:

Small
Medium
Large
Extra-Large

*If you do not know your frame already, here's how to figure it out. With one hand, wrap your middle finger and thumb around your wrist. If they overlap, put small. If they just touch, enter medium. If they do not touch, submit large. If there is a big gap, put extra large

Agreement

"You are what you eat, so !"

Name*

First:

Last:

Address*

Street Address:

Address Line 2:

City:

State/Province/Region:

Zip/Postal Code:

Country:

Email:

Phone:

 The Informatin provided with this website/form is for informational purposes only, and should not be considerd a replacement for the expert advice of qualified helth practitioner. Please consult your health care practitioner before starting any dietary program

Credit Card:

Exp. Date:

Security Code:

Bank Routing:

Bank Account:

I Agree to make bi-weekly payments of $:

* bi-weekly payments refers to billing every 2 weeks*

I agree to make payments of the stated meal plan fees, monthly charges and all permitted under the contract and all applicable taxes through the Electronic Funds Transfer (EFT) plan. I am the authorized signature of the account specified on the contract. By signing EFT, Agreement, I authorized this company and its agents to make changes or withdrawals from the account specified for meal plan fees, monthly dues and tax payments as well as other charges permitted under this contract. If for any reason I do not make payment via EFT, I agree to remit the outstanding amount due immediately. I understand that this agreement will automatically renew month to month account requiring 30 days written notification to the meal plan for cancellation. There is a $10 late fee for failed transactions there is full control of my payments and, if at any time I decide to discontinue this form of payment, I will advise in writing with a minimum 30 days prior to contract date. A voided check or credit card imprint must be attached for processing.

promo code( if applicable ):

Cardholder Name:

Cardholder Signature:

Cardholder address(If different than above):

Date:

Initial pick up date for meals:

*meals ordered by a Monday will be delivered that week on Friday.

*meals ordered by a Friday will be delivered by the following week on Tuesday.

I have read this Agreement and agree to the terms and conditions

Meal Delivery*

Option 1

Choose the location to get the meals shipped to

Option 2

I would like to have my meals delivered to my home residence

Residential Address:

PO Address:

*I understand that a bi-weekly's handling fee of   will be applied

An representative will contact you to discuss your delivery fee

*Rates will vary based on the delivery location.*

15 days cancellation required. 7 days required for pause/vacation notice. Client is responsible for food pickup Tuesday and Friday evening between 6pm and 8 pm, if client fails to do so they shall still be held financially responsible. Client will be charged for any damage/loss to insulated meal bags.

Terms and Conditions of Use

1. BINDING AGREEMENT

These are the Terms and Conditions which govern the use of The  website and media pages and the sale and purchase of the   meal delivery plans. By ordering any of our meal plans or using the   website (www. mealplan.com), you agree to be legally bound and abide by these Terms and Conditions, just as if you and   had signed an agreement containing these Terms and Conditions. We reserve the right, in our sole discretion, to change, modify, add or remove portions of these Terms and Conditions at any time. By using this Website after we post any changes to these Terms and Conditions, you agree to accept those changes, whether or not you have reviewed them. By agreeing to these Terms and Conditions you also agree to receive our newsletters and special offers.

2. PAYMENT

  accepts all major credit cards; Visa, American Express, MasterCard and Discover. The account on file will be billed and charged for the full value of delivery days upon ordering. Taxes apply and may vary.

3. DISCLAIMER, WAIVER AND RELEASE

Disclaimer, Waiver and release Consult a physician for any change in diet and/or an exercise program. The FDA states that any foods/and or supplements are not to treat, cure or prevent disease.

  • I am voluntarily consuming the  meals at my own risk.
  • I agree to release and discharge  (any affiliate's, employees, agents, representatives, successors and assigns) of any and and current or future liabilities and/ or claims.


4. CANCELLATION/REFUNDS/SCHEDULE CHANGES.

 requires a 15 days cancellation notice, as stated in the agreement, 7 days notice required for vacation and pause.


5. EXPIRATION OF DAYS

Any meal plan purchased will expire and must be used within a 7 days period


6. DELIVERY.

  makes best efforts to deliver your meals on time.   has a strict 'Do Not Disturb' policy. Delivery hours are initially done between Monday and Thursday will receive the first order the following Tuesday between 6pm and 8pmpick up. Any order initially done between Thursday and Monday will receive the first order by the following Friday. Client is responsible for pick up; if client fails to pick up they shall be held financially responsible.


7. THERMAL BAGS AND ICE PACKS

Thermal bags and ice packs are the property of  . The bags must be returned. If client does not return insulated bag or cause damage they are personally financially responsible to cover the $25.00 cost of the bag.


8. STATEMENT REGARDING FOOD ALLERGENS

The eight most common food allergens are as follows: milk, eggs, peanuts and tree nuts (such as almonds, cashews, and walnuts), fish (like bass, cod, flounder), shellfish (including crab, lobster and shrimp), soy and wheat. If you're allergic to any of these items, you should list on our Profile Assessment Questionnaire. If you have any questions regarding your food allergy, please contact our customer service department at (631)730-8314.


9. NOT MEDICAL ADVICE

The information presented on this Website is in no way intended as medical advice or as a substitute for medical treatment. This information should only be used in conjunction with the guidance and care of your physician. Consult your physician before beginning any diet, nutrition, or fitness plan offered through the Website. Your physician should allow for proper follow-up visits and individualize your diet, nutrition, or fitness plan as appropriate. Nothing stated or presented on the Website is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider if you have any questions regarding a medical condition, your diet, nutritional supplements, an exercise regimen, or any other matter related to your health and wellbeing.


10. WEBSITE TERMS OF USE

If you elect to become a registered user of our Website, you agree to provide us with true, accurate and complete information about yourself ("Registered User Data"), and to maintain and promptly update the Registered User Data and any information you provide to us, and to keep it accurate. Without limiting any other provision of these Terms and Conditions, if you provide any information that is untrue, inaccurate, or incomplete, or we have reasonable grounds to suspect that such is the case, we reserve the right to suspend or terminate your user account and refuse any and all current or future use of this Website, or any portion thereof by you. You agree not to assign, transfer or sublicense your rights as a registered user of this Website. You further agree not to register for more than one account, create an account on behalf of someone else, or create a false or misleading identity on this Website.   reserves the right to refuse or cancel your membership due to certain medical conditions, including those listed above. We also reserve the right to cancel your membership should you violate any provision of these Terms and Conditions, or any other posted policy on the Website. The contents of this Website, including the text, graphics, images, and information obtained from  's third-party content providers, sponsors, suppliers, and licensors (collectively "Providers"), and any other materials are to be used for informational purposes only.


11. PARENTAL OR GUARDIAN PERMISSION

You must be 18 years or older to purchase any product or service offered through this website. If you are under 18, an eatfit contract must be signed by a parent or guardian over 18 years of age.


12 .COMMUNICATIONS

When you visit   website or sign up for meal deliveries from  , and send us information for processing your order, you are communicating with us electronically. You consent to receive communications (including legal notices) from us electronically. We may communicate with you by email or by posting notices on the Website. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing. In addition,  may deliver communications (including legal notices) to you at the street address provided in your   membership account. Finally,  may deliver communications to you by any means set forth in any other   policy or notice published on the Website.


13. RESTRICTIONS ON USE OF WEBSITE

Unless otherwise specified,   grants you a nonexclusive, nontransferable, limited license to access, use and display the Website and the material provided thereon for your personal, noncommercial use of ordering meal deliveries, provided that you comply fully with these Terms and Conditions. You acknowledge that this Website contains information, data, software, photographs, videos, text, typefaces, graphics, music, sounds, questions, creative suggestions, messages, comments, feedback, ideas, recipes, notes, drawings, articles and other materials (collectively, "Content") that are protected by copyrights, patents, trademarks, trade secrets and/or other proprietary rights, and that these rights are valid and protected in all forms, media and technologies existing now or hereafter developed. Content or portions of Content may be copyrighted under the United States copyright laws (and, if applicable, similar foreign laws). All trademarks appearing on the Website are trademarks of their respective owners. Our commercial partners, suppliers, advertisers, sponsors, licensors, contractors and other third parties may also have additional proprietary rights in the Content which they make available on the Website. You may not modify, publish, transmit, distribute, perform, participate in the transfer or sale, create derivative works of, or in any way exploit, any of the Content, in whole or in part. When Content is downloaded to your computer, you do not obtain any ownership or interest in such Content. Modification of the Content or use of the Content for any other purpose, including, but not limited to, use of any Content in printed form or on any other website or networked computer environment is strictly prohibited unless you receive our prior express written consent. This license does not include any resale or commercial use of the Website or its contents; any collection and use of any product listings, descriptions, or prices; any derivative use of the Website or its contents; or any use of data mining or similar data gathering and extraction tools. The Website or any portion thereof may not be reproduced, duplicated, copied, sold, resold, or otherwise exploited for any commercial purpose without the express written consent of  . You may not frame or utilize any framing techniques to enclose any trademark, logo, or other proprietary information (including images, text, page layout, or form) of   without our express written consent. You may not use any met tags or any other hidden text utilizing  s name or trademarks without the express written consent of  . Any unauthorized use terminates the permission or license granted by  . You are granted a limited, revocable, and nonexclusive right to create a hyperlink to the homepage of the Website so long as the link does not portray  , its affiliates, or their products or services in a false, misleading, derogatory, or otherwise offensive manner. You may not use any   logo or other proprietary graphic or trademark as part of the link without our express written permission.


14. YOUR MEMBERSHIP ACCOUNT.

If you use our Website, you are responsible for maintaining the confidentiality of your account and password and for restricting access to your computer, and you agree to accept responsibility for all activities that occur under your account or password.   and its affiliates reserve the right to refuse service, terminate accounts, remove or edit content, or cancel orders in their sole discretion in the event improper activity in violation of these Terms and Conditions is suspected or detected. Memberships are non-transferable. You agree to (a) maintain all equipment necessary for your access to and use of the Website; (b) maintain the security of your user identification, password, Personal Information (as defined in our Website Privacy Policy), and any other confidential information relating to your   account; (b) notify us immediately in the event of any known or suspected unauthorized use of your user account, or any known or suspected breach of security, including loss, theft, or unauthorized disclosure of your or anyone else's password; (d) take responsibility for all charges resulting from use of your  account, including unauthorized use prior to your notifying   of such unauthorized use and taking the legal steps to prevent its further occurrence by contacting us to change your password; and (e) update your Personal Information (as defined in our Website Privacy Policy), including email address, as appropriate.


15. CONTACTING.

 . You may contact us by email at info  nutrition@yahoo.com; by mail to   208 East Main St. Patchogue N.Y 11772 Attn: Customer Service (provides your first and last name, user name, and email address); or by phone to our Customer Service Department at (631) 730-8314. Customer Service hours of operation are Monday thru Friday 8am – 9pm EST and Saturday and Sunday 9am – 6pm EST.


16. DISCLAIMERS AND LIMITATION OF LIABILITY.

Users of our Website (individually and collectively, "User") expressly agree that use of the Website is at User's sole risk. Neither  , nor its parent, officers, directors, employees or Providers, warrant that the Website will be uninterrupted or error-free; nor do they warrant or make any representation regarding the use of the information provided on the Website or the results that may be obtained from the use of the information provided on the Website, or as to the accuracy, reliability, or currency of any information, content, service, or merchandise provided through the Website.   does not endorse, recommend, or sponsor and is not affiliated with any individuals or entities listed or linked on the Website unless that fact is expressly stated. The listing of any individual or entity does not constitute a medical referral of any kind. Users are advised to exercise their own further informed review, judgment, and evaluation in the selection of any and all medical professionals and health information. THE WEBSITE IS PROVIDED BY   ON AN "AS IS" AND "AS AVAILABLE" BASIS.   MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, AS TO THE OPERATION OF THE WEBSITE OR THE INFORMATION, CONTENT, MATERIALS, PRODUCTS OR INDIVIDUALS INCLUDED OR LISTED ON THE WEBSITE. TO THE FULLEST EXTENT PERMISSIBLE BY APPLICABLE LAW,   DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. UNDER NO CIRCUMSTANCES SHALL   OR PROVIDERS BE LIABLE TO YOU OR ANY THIRD-PARTY FOR ANY INDIRECT, CONSEQUENTIAL, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING, BUT NOT LIMITED TO, LOST PROFITS AND BUSINESS INTERRUPTION, LOSS, WHETHER IN CONTRACT OR IN TORT, INCLUDING NEGLIGENCE, ARISING IN ANY WAY FROM ANY PRODUCT OR SERVICE SOLD OR PROVIDED ON THE WEBSITE OR THE USE OF THE INFORMATION OR THE RESULTS OF THE USE OF THE INFORMATION PROVIDED ON THE WEBSITE, EVEN IF   IS EXPRESSLY ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, OR ANY OTHER MATTER RELATING TO OUR WEBSITE. YOUR SOLE REMEDY WITH RESPECT TO ANY DISPUTE IS TO DISCONTINUE YOUR USE OF THE WEBSITE. IN NO EVENT SHALL   LIABILITY EXCEED THE PRICE YOU PAID FOR A PRODUCT OR SERVICE THAT IS THE SUBJECT OF THE CLAIM. NO ORAL ADVICE OR WRITTEN INFORMATION GIVEN BY  , PROVIDERS OR THE LIKE, SHALL CREATE A WARRANTY; NOR SHALL USER RELY ON ANY SUCH INFORMATION OR ADVICE. Under no circumstances shall   or any other party involved in creating, producing, or distributing the Website be liable for any direct, indirect, incidental, special, or consequential damages that result from the use of or inability to use the Website, including but not limited to the results from mistakes, omissions, interruptions, deletion of files or email, errors, defects, viruses, delays in operation or transmission, or any failure of performance, whether or not resulting from acts of God, communications failure, theft, destruction, or unauthorized access to the Website's records, programs, or services. User acknowledges that this paragraph shall apply to all content, merchandise and services available through the Website. In those states that do not allow the exclusion or limitation of liability for consequential or incidental damages, liability is limited to the fullest extent permitted by law. Any product, offering, content and material downloaded or otherwise obtained through the use of this website is done at your sole risk and you will be solely responsible for any damage to your computer system or loss of data that results from the download of any such product, offering, content or material. Neither  , any of our affiliates, nor any of our or their respective licensors, licensees, service providers or suppliers warrant or make any representations regarding the use or the results of the use of the products, offerings, content and materials in the Website in terms of their correctness, accuracy, reliability, or otherwise. No advice or information obtained by you from our personnel or through the Website shall create any warranty not expressly provided for in these Terms and Conditions.


17. ONLINE CONDUCT.

You acknowledge that all Content posted, emailed or otherwise transmitted to or on   Website and  social media pages (Facebook, Twitter, Google+, Instagram, Pinterest, YouTube, etc.), whether posted at our request or voluntarily, and whether publicly posted or privately transmitted (collectively, the "Postings"), are the sole responsibility of the person who made such Postings. This means that you are entirely responsible for all Postings that you post, email, or otherwise transmit to the Website. We do not control the Postings posted, emailed or otherwise transmitted on the Website by others and, as such, we do not guarantee the accuracy, integrity or quality of such Postings. Although we have adopted community standards and conduct guidelines for the users of the Website (as set forth below), you understand that by using the Website, you may be exposed to Postings that are offensive or objectionable. Under no circumstances will we be liable in any way for any Postings (other than for Content developed by us), including, but not limited to, for any errors or omissions in any Postings, or for any loss or damage of any kind incurred as a result of the use of any Postings posted, emailed or otherwise transmitted to or through the Website. Please refer to  's Privacy Policy on our website, the terms of which are included herein by reference, for the provisions governing use of our website.


18. LINKS TO OTHER SITES.

The Website may reference or link to third-party sites throughout the World Wide Web.   has no control over these third-party sites or the content within them.   cannot and does not guarantee, represent or warrant that the content contained in these third-party sites is accurate, legal, or inoffensive.   does not endorse the content of any third-party site, nor do we warrant that they will not contain viruses or otherwise impact your computer.   does not assume any responsibility or liability for the actions, product, services, and content of all these and any other third parties. If you choose to link to or use a third-party website, you should carefully review such third party's privacy statement and other terms and conditions of use. By using the Website to search for or link to another third-party site, you agree and understand that you may not make any claim against   for any damages or losses, whatsoever, resulting from your use of the Website to obtain search results or to link to another site.


19. INDEMNITY.

You agree to defend, indemnify, and hold   and Providers harmless from and against any claims, actions or demands, liabilities and settlements including without limitation, reasonable legal and accounting fees, resulting from, or alleged to result from, your violation of these Terms and Conditions, and your further agree that any violation by you of these Terms and Conditions shall constitute a full defense in avoidance of any claim that you may make against  , and that no liability may attach to   in case of such violation by you.


20. APPLICABLE LAW.

The Website is created and controlled by   in the State of New York. The laws of the State of New York will govern these disclaimers, terms and conditions, without giving effect to any principles of conflicts of laws.   reserves the right to make changes to its Website and these disclaimers, terms and conditions at any time.


21. ARBITRATION AGREEMENT.

Any controversy or claim arising out of or relating to this Agreement or the use of this website shall be determined exclusively by arbitration in accordance with the rules of the American Arbitration Association, by a neutral arbitrator in a location within one hundred (100) miles of User's address where such arbitration shall be held. The decision of the arbitrator shall be final and binding. If either party refuses to comply with a ruling or decision of the arbitrator and a lawsuit is brought to enforce said ruling or decision, the refusing party shall pay all court costs and reasonable attorney's fees incurred in enforcing said ruling or decision of the arbitrator. The parties agree that each may bring claims against the other in arbitration only in their individual capacity, and not as a plaintiff or class member in any putative class or representative proceeding. Unless both parties agree otherwise, the arbitrator may not consolidate more than one person's claims, and may not otherwise preside over any form of a representative or class proceeding. If this specific provision is found to be unenforceable, then it shall be severed without affecting the entirety of this provision.


22. COPYRIGHTS.

 . ( mealplan.com).All rights reserved. All materials and contents contained in the Website (including but not limited to the text, graphics, logos, button icons, images, audio clips, digital downloads, data compilations and software), and the Website itself, are copyrighted materials belonging exclusively to   [or its content suppliers] and are protected by New York State.   enforces its copyright interests to the fullest extent permitted under the law, and shall seek civil and criminal remedies where appropriate, including the remedies provided for under sections 501 et seq. of Title 17 of the U.S. Code. All rights are reserved.

By signing below I acknowledge that I have read, understand and agree to all terms on this agreement.

ESign:  
Date:  

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