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Distributors Application Form
This form is for interested Distributors only.
* Indicates required question
NAME
*
Your answer
AGE
*
Your answer
COMPLETE ADDRESS
*
Your answer
CONTACT NUMBER
*
Your answer
FACEBOOK URL/ LINK
*
Your answer
How can we contact you?
*
Fb Messenger (kindly check Spam or Hidden Messages)
Viber
FOR WHICH BRAND?
REJUVIANT
NAKIZ
BOTH
Clear selection
POSITION THAT YOU ARE APPLYING FOR?
*
REGIONAL DISTRIBUTOR
PROVINCIAL DISTRIBUTOR
CITY DISTRIBUTOR
UNDER WHAT REGION?
*
Choose
NCR 1
NCR 2
REGION I - Ilocos
REGION II - Cagayan Valley
REGION III - Central Luzon
REGION IV-A - CALABARZON
REGION IV-B - MIMAROPA
REGION V - Bicol
VI-Western Visayas
VII-Central Visayas
VIII-Eastern Visayas
IX-Zamboanga Peninsula
X-Northern Mindanao
XI-Davao Region
XII-SOCCSKSARGEN
XIII-Caraga
CAR - Cordillera Administrative Region
BARMM - Bangsamoro Autonomous Region in Muslim Mindanao
EXACT LOCATION OF YOUR AREA?
*
FOR PROVINCIAL & CITY ONLY. PLEASE BE SPECIFIC. INCLUDE THE PROVINCE OR CITY. (Write N/A if applying for Regional)
Your answer
WHY SHOULD WE CHOOSE YOU TO BE OUR DISTRIBUTOR OF YOUR CHOSEN AREA?
*
Your answer
WHAT OTHER BRANDS ARE YOU HANDLING?
*
Your answer
Submit
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