Agent Application Form
Innomax Store
Applicant Name *
Business Name
Email *
Business Address *
Phone number *
Website
Are you currently a seller? *
If you are a seller, where do you sell? *
What Products are you selling / interested to sell? *
What is your current Sales Turnover? (Per Month) *
Which geographic area are you interested to sell? *
Where do you hear about us?
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Other Comments / Remarks
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