Digital Assistance Form

Digital Assistance Form
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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.Format: (0000) 000-0000.
Email Address
example@example.com
Validity of Authorization
Date From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type of Assistance (you may choose more than one)
For your first transaction through Digital Assistance Form, will you be visiting the Branch or do you prefer assistance through video call?
For your first transaction through Digital Assistance Form, will you be visiting the Branch or do you prefer assistance through video call?
Date of Visit

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preferred Application for Video Call

Other
Account Name of FB Messenger/Viber/other app for Video Call
Preferred Date and Time to be contacted by the Branch
Password Reset
Email Address where to send new password
Place Order
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

More items to order?

ePayment
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
Take a selfie to validate your identity.
Please upload your Avon ID or any valid Proof of Identification (front and back)

Cancelof
Declaration and Agreement
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.
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.
Data Privacy Undertaking
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.
Signature
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Digital Assistance Form

Password Reset

Place Order

ePayment

Declaration and Agreement

Data Privacy Undertaking