Longrich Nigeria Order Form

Longrich Nigeria Order Form

Fill out the form below to be registered as a distributor.
FIRST NAME
LAST NAME
SEX
PHONE NUMBER
EMAIL ADDRESS
DATE OF BIRTH

DayMonthYear
CITY YOU LIVE IN
STATE
Distributor Level
Choose the Level you wish to Join
CHOOSE A LEVEL
CHOOSE YOUR PRODUCTS

Select the products you want from the list. See price & PV (point value) of each product.
PERSONAL CARE
WOMEN CARE
BABY CARE
HEALTH SUPPLEMENTS
HEALTH DRINKS
ENERGY PRODUCTS
PAYMENT
Acct 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. Calculate the total PV & Amount. Ensure total PV is upto PV of your chosen Level of registration.
5. Make a Payment to Longrich Authorized Account.
6. Attach Receipt or Screenshot of Payment to Longrich.
7. Submit Form.
8. Receive your Distributor code in 48 hours and instructions to pick your products from the nearest delivery center to you.
Please verify that you are human
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