SIMPLY MOVING PHILIPPINES INC
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Dealer / reseller’s Application
Applicant Overview
The undersigned applicant ("Applicant") submits this Application to Segway Ninebot Philippines
(All non-public information about Applicant provided on this Application shall be held in
confidence by Simply Moving Philippines, Inc.)
*
Indicates required field
Full legal name of Applicant
*
First
Last
Trade Names under Applicant does business
*
Date incorporated or otherwise organized
*
Place of incorporation or organization
*
APPLICANT'S OFFICE ADDRESS
Address Line 1
*
Address Line 2
*
City
*
Province
*
Zip / Postal
*
Applicant's telephone / mobile number
*
Applicant's website
*
Applicant's Email Address
*
Sales Monthly Forecast
*
0-19 Units
10-20 Units
21-40 Units
41-60 Units
Proof of Identification (Government ID)
*
Max file size: 20MB
Proof of Identification (Government ID 2)
*
Max file size: 20MB
Please add me to the Segway email list for company, product and event updates
*
Yes
No
Submit
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