Reseller Enrolment Kit

DISTRIBUTOR APPLICATION/ENROLMENT FORM


1. Basic Information


2. BUSINESS INFORMATION

REGISTRATION STATUS (PLEASE TICK AS APPROPRIATE) (required)


3. DISTRIBUTION CATEGORY OF INTEREST

DISTRIBUTION CATEGORY OF INTEREST (PLEASE TICK AS APPROPRIATE) (required)


4. PRODUCT/SERVICE OF INTEREST

PRODUCT/SERVICE OF INTEREST (PLEASE ENTER AS APPROPRIATE) (required)










5. KEY STAFF DATA