Become an Agent / Distributor for Eeze Squeeze

Simply fill in the form below:

Want to Become an Agent / Distributor for Eeze Squeeze?

Full Name plus Surname *

Full name as per stated on ID

Name *

Preferred name you would like to be called

Phone *

Email *

Full Physical Address *

Suburb *

Province *

Postal Code *

How would you like to Collaborate? *

Agents (Less than 100 per order) | Distributors (More than 100 per order)

On what platform did you hear from us? *

If you selected Agent above, please give us their name

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Terms & Conditions

Agree

I have read the below terms & conditions and hereby agree to them.

*Please not this is only pre-registration and all benefits will only applied once the registration process is complete.

Distributors need to order a minimum of 100 Bangles per order to qualify for the distributor discount.

Terms & Conditions apply | Subject to Change