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RESELLER
APPLICATION FORM
We are pleased that your company is interested in becoming our Online Reseller in your area.
GreenLife Coconut Products Philippines Inc. is highly dedicated in providing our clients the
best products and services we can offer. In order to fulfill this, please provide us the following information:
2x2
TAXPAYER IDENTIFICATION NUMBER:
or
Email Address:
Instagram:
Twitter:
Website:
SECTION A: APPLICANT'S INFORMATION
COMPLETE NAME:
Birthdate:
COMPLETE ADDRESS:
House/Bldg No:
City/Municipality:
Street:
Province:
Barangay:
ZIP/Postal Code:
CONTACT DETAIL:
Tel No:
Mobile No:
Fax No:
SECTION B: COMPANY INFORMATION
Company/Shop Name:
COMPANY/DELIVERY COMPLETE ADDRESS:
House/Bldg No:
City/Municipality:
Street:
Province:
Barangay:
ZIP/Postal Code:
Please check the online platform you are currently in:
ONLINE STORE ACCOUNTS:
Facebook:
SECTION C: PAYMENT INFORMATION
Choose where you want to deposit your payment:
IN CASE OF EMERGENCY, WE MAY CONTACT THE FOLLOWING:
Complete Name:
Contact Number:
Please provide 2x2 picture, a copy of your valid ID as proof of Identification and proof of billing.
Certification of Official Distributor will be given after 5 consecutive order as an online reseller
I hereby certify that the above information are true and correct to the best of my knowledge.
I understand that a false statement may disqualify me for my benefits.
Green Life Coconut Products Philippines Inc.
KM144 Brgy. Wakas, Tayabas Quezon Province, Philippines 4327
website: www.greenlifecocoph.com | email: greenlifecocoph@gmail.com
contact number: +63917-720-8345 | (042) 719-1761
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