Digital Assistance Form

Date

Branch*

Branch Email

example@example.com

Account Name*

Given Name/sMiddle NameLast NameSuffix (SKIP if NOT APPLICABLE)

Account Number*

Mobile Number*

Please provide an active mobile number.

Email Address*

example@example.com

Validity of Authorization*

7 days15 days30 days

Date From*

Date

Date To

Date

Type of Assistance (you may choose more than one)*

Password ResetPlace OrderePayment

For your first transaction through Digital Assistance Form, will you be visiting the Branch or do you prefer assistance through video call?*

Visiting the BranchVideo Call (Please expect a video call from your Branch of Sign-In within two (2) hours upon submission of this form. For submissions beyond 4pm, please expect the video call on the following business day within the Branch operating hours.)

For your first transaction through Digital Assistance Form, will you be visiting the Branch or do you prefer assistance through video call?*

Visiting the BranchVideo Call

Date of Visit*

Date

Preferred Application for Video Call*

Facebook MessengerViberOther

Account Name of FB Messenger/Viber/other app for Video Call*

Preferred Date and Time to be contacted by the Branch*

Email Address where to send new password*

I agree to give access to the staff of Avon Name of Avon Branch* to assist me to place my order/s in Avon On/Avon Easy platform.

Delivery Address*

House/Lot/Building No, Street Name

Unit No, Building Name / Village or Subdivision

Barangay and District (if applicable)City or Municipality / Province

Postal / Zip Code

Products to be ordered*

	FSC	Product Description	Quantity
1
2
3
4
5
6
7
8
9
10

More items to order?*

YESNO

Products to be ordered*

	FSC	Product Description	Quantity
1
2
3
4
5
6
7
8
9
10

I give access to the Branch Staff of Avon Name of Avon Branch* to initiate payment in Avon On/Avon Easy platform. I also agree to share my account details for this type of transaction.

Mode of Payment*

Credit/Debit CardeWalletOver the CounterBank Transfer

Take a selfie to validate your identity.*

Please upload your Avon ID or any valid Proof of Identification (front and back)*

This is an authorization with no additional permissions for the dates specified above. I am responsible to change my password immediately after I leave the Branch to prevent further use by the Branch. Therefore, I take full responsibility for any purchases made beyond the date of this authorization.*

I agree

This is an authorization with no additional permissions for the dates specified above. I am responsible to change my password immediately after the video call to prevent further use by the Branch. Therefore, I take full responsibility for any purchases made beyond the date of this authorization.*

I agree

By voluntarily submitting your information in this form, you warrant that all the information you have given in this Form are true, complete and updated. You also consent that your personal information may be collected, stored, used, processed and shared by Avon Cosmetics, Inc. with its affiliates globally and third parties for legitimate business purposes, to fulfil your orders, provide appropriate commissions, discounts and incentives and manage your Representative account; to communicate with you and manage our relationship with you; to personalize and improve your Representative experience; to inform you about our products and offers that you may like; and to improve our services, fulfil our administrative purposes and protect our business interests. You also agree to the ACI’s Privacy Policy available at https://www.avon.ph/avon-ph/privacy-policy.html.*

I agree to the foregoing and to Avon’s Privacy Policy

Signature*

Digital Assistance Form

Password Reset

Place Order

ePayment

Declaration and Agreement

Data Privacy Undertaking