Pre-Qualification Form | Indochine Natural Malaysia

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If you are interested in retailing Indochine Natural products, or having us produce OEM/Private Label for your brand, we would like to hear from you.

For us to serve you best, all sections marked with a red Asterix * must be completed.

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* Company Name

Business Registration Number

* Contact person

* Website

* Job title

* Business address

* Phone

* Email

* Type of business (proprietorship, partnership, LLC)

* Number of years in business

* What best describes your business (retailer, online retailer, wholesaler, direct selling, other)

* Provide a brief description of your business

* Who is your target audience?

* Explain how Indochine Natural can assist in achieving your business goals.

* If you are a Malaysian company, are any of your products registered with the National Pharmaceutical Regulatory Agency (NPRA)? If yes, please provide the company name registered with NPRA.

* If you are a Malaysian company, are you willing to have any new products registered with NPRA ?

* Where did you hear about Indochine Natural?

* If you are currently retailing online or in a retail outlet, what brands of body care products are you currently stocking?

Is there any further information you would like to share with us?

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