Longrich Nigeria Order Form

Longrich Nigeria Order Form

Fill out the form below to be approved as Distributor
First Name*
Last Name*
Sex *
Date of Birth*
day/month/year
Phone*
E-mail*
City you live in*
State*
Choose Your Products

Select the products you need from the list.
PERSONAL CARE

Mouth FreshenerMosquito Repellant SprayAntiperspirant Roll onHandcreamToothpasteBody CreamBamboo SoapShampooBody Wash
WOMEN CARE

Sanitary NapkinsPantylinersSanitary Napkins (Heavy Flow)
BABY CARE

Baby Prickly Heat PowderBaby wash and ShampooBaby Moisturizing Cream
HEALTH SUPPLEMENTS

Green(Xinchang) TeaSlimming TeaBlood Fat Reducing TeaCalciumArthro Super ReviverLibao (Male Fertility)MengQian (Female Fertility)Berry OilCordyceps
HEALTH DRINKS

Health WineCordycep CoffeeNutrivPinkNutrivBlue
ENERGY PRODUCTS

Alkaline CupEnergy Pot (24cm)Energy Pot (28cm)Energy Shoes
Distributor Level

Choose the Level you wish to Join
Choose a Level*

STARTERPACK Level (N9,800)Q-SILVER Level (N25,000) - Earns 8% weekly bonusSILVER Level (N80,000) - Earns 8% weekly bonusGOLD Level (N130,000) - Earns 10% weekly bonusPLATINUM Level (N320,000) - Earns 12% weekly bonusVIP Level (N750,000) - Earns 12% weekly + 1% share of global sales
Payment
Make a Payment to LONGRICH AUTHORIZED ACCOUNT Acct Name: Longrich Int’l Nigeria Acct no = 1012908177 Bank = Zenith BankAcct Name: Longliqi Int’l Nig Acct no = 1012908177 Bank = Zenith Bank
Upload your Payment Receipt *VERY IMPORTANT*

Browse Files
Upload your payment receipt Cancelof
Special Instructions:
1. Fill out the Form
2. Choose an entry Level.
3. Select your Products.
4. Make a Payment to Longrich Authorized Account.
5. Attach Receipt or Screenshot of Payment to Longrich.
6. Submit Form.
7. Receive your Distributor code in 72 hours and instructions to pick your products from the nearest delivery center to you
Please verify that you are human*
Should be Empty:

Longrich Nigeria Order Form

Choose Your Products

Distributor Level

Special Instructions: