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Reseller's Form
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* Indicates required question
Email
*
Your answer
Name
*
Surname, First Name, Middle Name
MM
/
DD
/
YYYY
Address
*
No, Street Name, Subdivision, Brgy, City/Province, Zip Code
Your answer
Contact Number
*
Your answer
Target Location
*
Your answer
Mode of Reselling
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Online
Store
Home Based
Other
Required
If Other Mode of Reselling, please specify
*
Your answer
Business Name (Please Type N/A if not Applicable)
*
Your answer
Address
*
Your answer
Business Phone number
*
Your answer
Do you sell other products?
*
Yes
No
What other products/brands do you sell? *
*
Your answer
Do you sell other Chicharon & Barbecue products? If YES - what brands?
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Your answer
Do you sell other Chicharon & Barbecue products? If YES - what brands?
*
Yes
No
Maybe
Does your LGU have any restrictions in receiving Pork Meat Products?
*
Yes
No
Don't know
Do you have a preferred logistics company in shipping your products? *
*
Yes
No
Other:
Please provide your preferred shipping company from R.Lapid's Production Office in Valenzuela to your location
*
Your answer
What R.Lapid's Branch is Located near your area?
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Your answer
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