OEM Customer Registration Form
This Form is Created by Melscen Lab, we are collecting the information for better understanding your requirements
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Postcodes
Phone Number
*
-
Area Code
Phone Number
E-mail
example@example.com
Website
Your Company/Business name
*
ABN (Australia Business Number)
*
Industry Types (e.g. Retail, Hotel, Perfume, Please indicate if new start up)
*
Estimated Order Quantity for First Batch (e.g. 5L/10L/20L Custom)
*
Preferred Fragrance Notes
*
What is your Target Market ( Women, Men, Unisex)
*
Do you require to assist with Labeling and Ingredients Requirements
*
Yes
No
Do you need help with sourcing bottle and packaging?
*
Yes
No
Please upload any pictures or ideas you like!
Browse Files
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Choose a file
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of
Signature
I agree to submit this form behalf of this Company/Business)
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Submit
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