Medifast Fit for Kids Registration Form

Brought To You By

Terry & Nancy Pettit

New Customers Register Below!

To order great MediFast products, you will need to first register using the form below.

It's free, fast, and will speed up any
of your future orders!

Customer Login

Already a Take Shape for Life Customer? Login Here!

Customer ID:

Password:


Forgot Your Password? Click Here!

Need Help Ordering?
Phone 1-800-621-1927
Want to mail or fax your order?
Click here to download the offline order form

(Note: be sure to register below if you haven't already done so- Orders are not accepted without a valid ID number)

New Customer Registration - Customer Information

* Referring Health Advisor:

PETTIT, TERRY A

* Referring Health Advisor ID:

9232

* Last Name:

* First Name:

Email Address:

* Home Phone:

Mailing Address

* Mailing Address:

Mailing Address 2:

* City:

* State:

* Zip Code:

Shipping Address
(if different than above mailing address)

* Shipping Address:

Shipping Address 2:

* Shipping City:

* Shipping State:

* Shipping Zip Code:

Choose Your Customer Password

* Your Desired Password:

* Confirm Your Password:

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