INDEPENDENT DEALER

APPLICATION FORM
We are pleased that your company is interested in becoming our Online Distributor in your area.
GreenLife Coconut Products Philippines Inc. is highly dedicated in providing our clients the
best products and services we can offer. In order to fulfill this, please provide us the following information:
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2x2
TAXPAYER IDENTIFICATION NUMBER:
or
Email Address:
Contact Person:
Position:
Email Adress:
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Office Address:
ZIP/Postal Code:
Phone No.
Number of Yrs in Business:
Capitalization:
Website:
Existing Sales Channels (Kindly state URL if applicable. Use separate sheet if necessary)
A. Local Store I Outlets
B. Overseas Stores I Outlets:
C. Social Media Accounts:
E. Others (e.g. OLX ebay, etc... Please specify):
For Single Proprietorship Only
Name of Proprietor:
TIN:
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For Partnership & Corporation Only
Board of Directors
Company Officer:
President:
Vice President:
General Manager:
Company Representatives
A.Orders
Name:
Positon:
Specimen Signature:
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B. Collection of Payments
Name:
Positon:
Specimen Signature:
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C. Customer Information Sheet Signatory
Name:
Positon:
Specimen Signature:
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SECTION B: COMPANY INFORMATION
For Single Proprietorship Only
TINID/VAT Registration Cert.
DTI Registration Cert.
Mayor's Permit
For Partnership/Corporation
Other Documents,if any
TINID/VAT Registration Cert.
SEC Reg. Cer
SEC Articles of Incorporation/Articles of Partnership
Mayor's Permit
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SECTION A: APPLICANT'S INFORMATION
COMPLETE NAME:
Birthdate:
COMPLETE ADDRESS:
House/Bldg No:
City/Municipality:
Street:
Province:
Barangay:
ZIP/Postal Code:
CONTACT DETAIL:
Tel No:
Mobile No:
Fax No:
SECTION B: COMPANY INFORMATION
Company/Shop Name:
Please provide 2x2 picture, a copy of your valid ID as proof of Identification and proof of billing.


I hereby certify that the above information are true and correct to the best of my knowledge.
I understand that a false statement may disqualify me for my benefits.
Green Life Coconut Products Philippines Inc.
KM144 Brgy. Wakas, Tayabas Quezon Province, Philippines 4327
website: www.greenlifecocoph.com | email: greenlifecocoph@gmail.com
contact number: +63917-720-8345 | (042) 719-1761