Ultrafresh Retailer Information Sheet
Personal Details
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Mobile Number
*
format starts: +63
E-mail
*
example@example.com
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Reseller Information Sheet
Financial Details
Employment Information
Employment History
*
Employer
Position
Duration
1
2
3
Current Monthly Income
Salary
net in Philippine Peso
Business
net in Philippine Peso
Investments
(if applicable) net in Philippine Peso
Others
enter in comma separated value
Business Details
Business Engagement Status
*
I already have a registered retail business.
I am planning to register a retail business.
I do not have any plans on opening a retail business.
In what City / State are you interested in becoming a reseller?
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Reseller Information Sheet
Acknowledgment & Signature
Acknowledgement
I hereby certify that the above information contained in this Reseller Information Sheet is true and correct. In accordance with the Data Privacy Act, I acknowledge and understand that the above information will be utilised by `Salmo Trading and Distribution Corporation` in its evaluation of my intent to become a reseller of `Ultra Fresh` diapers.
Full Name
Date
-
Month
-
Day
Year
Signature
Clear
Submit
Should be Empty: