Distributor Registration Form
Distributor Login Information 配銷商登入资料:: 9/9/2010 12:33:48 PM
Distributor Login Password 登入密碼 :
Confirm Distributor Login
Password 密码确定:
EWallet Password 電子钱包密碼:
Confirm EWallet Password 密码确定:
 
Distributor Information 配銷商个人资料
  Name 姓名:    
  NRIC/Passport No 身份证号码:  
  Date of birth 出生日期: - - (dd-mm-yyyy)
  Gender 性别: Male 男     Female 女
  Marital Status 婚姻状况: Single 单身  Married 已婚
 
Address 地址:
 
Postcode 邮区代号:
Town / City 城市:
Country 國家:
Telephone No (H) 住宅电话:
Telephone No (O) 办公电话:
Telephone No (Mobile) 手机号码:
Fax No 傳真電話:
Email Address 电邮:
 
Beneficiary Information 受益人资料
  Name of Beneficiary 受益人姓名:
  NRIC/Passport No 身份证号码:
  Date of birth 出生日期: - - (dd-mm-yyyy)
  Gender 性别: Male 男    Female 女
 
Introducer & Upline Information 介紹人與上線個人資料
Introducer ID 介紹人编号:
Introducer Name 介紹人姓名:
Placement ID 放置上線编号:
Placement Position 放置上線地位: Left 左 Right 右
 
  Remarks 備注:
 
New Purchases
Product Code Description 產品 BV Unit Price 單價 Quantity 數量 Total BV 總BV Total USD 總美金
T001 SOG3 120.00 188.00
T002 CitiMagma 120.00 188.00
T003 Green Clay Soap - Savon d'Agile 120.00 188.00
Total Amount 總數: 
 
  Payment Mode 付款方式:
*** For Payment By EWallet 使用電子钱包付款***
EWallet ID 電子钱包编号:
Password 電子钱包密碼:
*** For Payment By Credit Card 使用信用卡付款***
(the bonus will be given after the credit card verification) (花紅將予信用卡確認后付出)
Card Type 信用卡類型:
Name On Card 信用卡用戶名:
Card Number 信用卡號碼:
3 Digit Code (Back Card) 确认码(卡后):
Expiry Date 终止日期: -
 
  Special Terms & Conditions
  I have received, read and understood the Compensation Plan and Terms and Conditions of this Agreement and acknowledge that I have NO unanswered questions concerning same. I further agree that you, elingobiz.com will have the right to amend this Agreement at any time in the future on the basis that the amendments are required for the efficient operation of the Compensation Plan. I also declare that all the above information provided by me is correct.