DISTRIBUTOR APPLICATION - JO'M COSMETICS
Questions marked by * are required.
1.
Name: *
2.
Surname: *
3.
ID Number : *
4.
Gender :
-
Male
Female
5.
Age (years) :
-
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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25
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84
85
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89
90
91
92
93
94
95
96
97
98
99
100+
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 :
-
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
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 R1500 including 25% discount (Your JO'M order must always be a minimum of R2000 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)