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Representation Form
Applicant's details
NAME
*
Mobile Phone
*
Nationality
*
Email address
*
Work address
*
Work phone
*
shop and warehouse specifications
shop phone
shop ownership
Select item
Personal
Rental
Area
Central warehouse address
Central warehouse phone
Warehouse ownership
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Personal
Rental
Area
How it works
retail sales quantity per month to the consumer
Select item
More than 2000 meters
More than 4000 meters
More than 6000 meters
More than 10000 meters
distributor sales quantity per month to partner
Select item
More than 2000 meters
More than 4000 meters
More than 6000 meters
More than 10000 meters
do you sell to any other area?
Select item
Yes
No
if yes, please mention wich cities
what product do you need?
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