Pre-Qualification Form

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.

*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.

*Is your company and/or any products registered with the National Pharmaceutical Regulatory Agency (NPRA), Malaysia. If yes, please provide the company name registered with NPRA.

*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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