Authorize Distributors Application Form
Please complete the form below.
Full Name
First Name
Middle Name
Last Name
Age
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
example@example.com
Phone Number
When did you start reselling our products?
/
Month
/
Day
Year
Date
I am a...
Please Select
Reseller
City Distributor
Province Distributor
I sell Fruit&Scent Perfume through...
Please Select
My Physical Store
My Online Shop
My Resellership
Estimated Monthly Stocks
Please Select
10-50
51-100
101-more
Where do you sell?
Location - Address (For Resellers)
Source of Stock
If from a City/Provincial Distributor, indicate the name. If you are a reseller of Mr. Monsale, type Main Office.
Q1 and Q2 are questions to be answered by CITY/PROVINCIAL Distributors ONLY!
City/Provincial Distributors are those who have 100-more stocks and have resellers under them.
Q1: How many active resellers do you have?
Q2: Check the following regions that your resellers located at.
NCR
CAR (Abra, Apayao, Benguet, Ifugao, Kalinga, Mountain Province)
Region 1 (Ilocos Norte, Ilocos Sur, La Union, Pangasinan)
Region 2 (Batanes, Cagayan, Isabela, Nueva Vizcaya, Quirino)
Region 3 (Aurora, Bataan, Bulacan, Nueva Ecija, Pampanga, Tarlac, Zambales
Region 4 (Batangas, Cavite, Laguna, Quezon, Rizal)
Region 4b (Marinduque, Occidental Mindoro, Oriental Mindoro, Palawan, Romblon)
Region 5 (Albay, Camarines Norte, Camarines Sur, Catanduanes, Masbate, Sorsogon)
Region 6 (Aklan, Antique, Capiz, Guimaras, Iloilo, Negros Occidental)
Region 7 (Bohol, Cebu, Negros Oriental, Siquijor)
Region 8 (Biliran, Eastern Samar, Leyte, Northern Samar, Samar, Southern Leyte)
Region 9 (Zamboanga del Norte, Zamboanga del Sur, Zamboanga Sibugay)
Region 10 (Bukidnon, Camiguin, Lanao del Norte, Misamis Occidental, Misamis Orientalr)
Region 11 (Davao de Oro, Davao del Norte, Davao del Sur, Davao Occidental, Davao Oriental
Region 12 (Cotabato, Sarangani, South Cotabato, Sultan Kudarat)
Region 13 (Agusan del Norte, Agusan del Sur, Dinagat Islands, Surigao del Norte, Surigao del Sur)
How did you hear about us?
Please Select
Event
Social Media
Family / Friend
Submit
Should be Empty: