DISTRIBUTOR APPLICATION - JO'M COSMETICS
Questions marked by * are required.
1. Name: *
2. Surname: *
3. ID Number : *
4. Gender :
5. Age (years) :
6. Email : (make sure it is correct) *
7. Cell/ Mobile : *
8. Alternative Number :
9. Physical Address : (for courier purposes)
10. City /Town / Suburb/ Township :
11. Postal Code :
12. Province :
13. I agree to buy JO'M products at 25% discount and resell at original prices only : *
  • Yes
14. I agree to always spend/pay a total minimum of R600 including 25% discount (Your JO'M order must always be a minimum of R800 before discount) : *
  • Yes
15. Only your name, email, contact details and area will be published on JO'M website under stockist : *
  • Agree
16. Upload your LOGO (if you have)