Coklat Alfa Genius: Dropship Registration Form

Dropship Registration Form

Complete the form below to be one of our dropship!
Name*

First NameLast Name
E-mail*
Phone Number:*

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date:*

MonthDayYear
Store Information
Store Name:*
Store Type:*

Website/BlogFacebookInstagramPhysical Store
Store URL:*
Dropship Agreement
Type:*

Dropship
Untuk mendaftar sebagai DROPSHIP, anda dikehendaki untuk membayar yuran pendaftaran sebanyak RM 20 seumur hidup. Komisyen yang diberikan kepada agent dropship adalah 10% untuk setiap produk. Sistem dropship ini berfungsi seperti yang telah dijelaskan di sini: Dropship
By clicking the box below, I understand the information stated above and I agree to the terms and conditions by www.coklatalfagenius.blogspot.com*

I have read, understood, and accepted the rules for membership.
Payment Information
Anda dikehendaki untuk membuat pembayaran sebanyak RM 20 seumur hidup untuk yuran pendaftaran Agent Dropship. Pembayaran hendaklah dibuat di akaun bank yang tertera di bawah:

CIMB Bank : NZ AURA SERI (8600503664)
Maybank : NZ AURA SERI (562209-627111)
RHB Bank : NZ AURA SERI (1-6235-0010307-6)
BANK*
Proof of Payment:*

Upload a File

Cancelof
Enter the message as it's shown*
Once you submit your application, we will contact you shortly to confirm your dropship application.

Thank you!
Should be Empty:

Dropship Registration Form