Distributors Goods Request General Information Are you an Aleoba Distributor * Yes No- working under a distributor Please Upload You Aleoba Distribution Certificate * List of goods requested ( It should not be more done 2 types of goods for beginers) * First Name * Middle Initial Last Name * Phone Number * Email Address * Enter Email Date of Birth * Gender * Male Female Address * Marital Status * Married Single OtherOther Dependents? * Yes No How Many Dependents Live With You? Current Residence * Own Rent Years at Current Residence * End Section Next Financial Information Employer * Position/Title * Years With Employer * Company Address Are You Self-Employed? * Yes No Employer Contact Number * Monthly Income * Other Income End Section Employment History Please list employment history for the past 3 years beyond current employer Employer * Postion/Title * Years With Employer * Monthly Income * End Section Terms of Payment Will you be able to pay online? ( Payments are only required to be done online) * Yes No Goods Payment Period * One Month or less at 0% Fee Two Months at 5% Fee Three Months at 10% Fee End Section Next Legal Declarations If you answer yes to any of these questions, please use continuation sheet for explanations. Are there any outstanding judgements against you? * Yes No Have you declared bankruptcy in the past 7 years? * Yes No Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? * Yes No Are you party to a lawsuit? * Yes No Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? * Yes No Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? * Yes No Is any part of the down payment borrowed? * Yes No Are you a co-maker or endorser on a note? * Yes No Are you obligated to pay alimony, child support, or separate maintenance? * Yes No Please provide explanation for any answers you responded to affirmatively above: * Are you a citizen of your country of distribution? * Yes No Are you a permanent resident alien? * Yes No Have you had an ownership interest in a business in the last three years? * Yes No End Section Next Final Acknowledgement By signing this, I/we give permission to Aleoba to take any action against me/us if I/we gave inaccurate information about me/us. I also give permission to Aleoba to take action by law if by any means I will try to fraud the company through this system. Aleoba may inquire into my/our credit history and use such information to explore potential financing alternatives. I/we understand and agree to the potential Aleoba is giving me/us. I promise to pay all the goods I will receive in full. I understand that these goods will not include my distribution after-sale fee. Consent * I agree End Section If you are human, leave this field blank. Submit 2021-02-02
