Zynergia - Outlet Store Application Form

OUTLET STORE APPLICATION FORM

PLEASE PREPARE TO UPLOAD THE FOLLOWING:

Contract Lease, DTI/SEC, Certificate of Registration, Mayor’s Permit, BIR Permit and Business Permit.

Date signed:

Salutation:

First name:

Middle name:

Last name:

Suffix:

Birthdate:

Date of Membership:

Facebook name:

Mobile Number:

Email address:

Telegram Account No.

Resedential Address (Home address)

Apartment/Unit No:

Street Address:

Barangay:

City:

Zip code:

Physical Address (Business Center Address)

Apartment/Unit No:

Street Address:

FB Page name:

Center Portal username:

Membership username:

Barangay:

City:

Zip code:

How many S.Q.M?

Area of Coverage:

Schedule of Operation:

Opening Hours:

Authorized Representative Name:

Are you a ZNP? What Batch?

Upload the following:

Contract lease:

UPLOAD CONTRACT

DTI / Sec:

UPLOAD DTI/SEC

Certificate of registration:

UPLOAD CERTIFICATE

Mayor's Permit:

UPLOAD PERMIT

BIR Permit:

UPLOAD DTI/SEC

Certificate of registration:

UPLOAD CERTIFICATE

Finder's Fee claimant / Referred by: