Distributorship Request Form
Thank you for your support and for choosing to sell and promote Lasena Natural Alkaline Mineral Water

Lasena is fully dedicated to help you build a successful business.

This form should only take 2-4 minutes to complete.
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**PLEASE NOTE** Requirements
**After filling out this request form you will receive your invoice breakdown and payment details.

**An assigned brand coach/ marketer will contact you to follow up on our onboarding process and to schedule your delivery.

** Our offers are subjected to change please check back frequently or visit our website for offer updates.
How did you get to know about Lasena Water? *
Name *
First and Last name
Email *
Phone Number *
Business Name *
Business Address *
Nearest Land Mark *
Please enter your Nearest Land Mark below
L.G.A *
Please enter your Local Government Area below
State *
Please enter your State below
What do you know about Lasena Alkaline Mineral Water? *
Do you currently buy/drink Lasena Natural Alkaline Mineral Water? *
What is your Storage Capacity? *
Do you sell other products either now or in the past? *
Do you currently have an Existing customers base? *
How do you intend to sell / redistribute our product ? *
Do you currently have or own a vehicle for redistribution? *
I Agree to under go Lasena product training *
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