Instructions & Notes:
1) Look over each question carefully and fill out the required fields that apply to your situation. (An asterisk ( * ) means field is required, otherwise, it's optional.) Please be generous with your information as this is the criteria we will need to approve your application.
2) Hitting the TAB key takes you to the next field.
3) Please doublecheck all details before hitting the submit
button at bottom of form. (submit only once please)
4) Please allow us some time to look over your application details
before re-contacting us. Under normal circumstances, we will
issue you a reply in less than 7 days. If we need additional
information, we will contact you with the specifics.
General
Information:
Complete
Name of Applicant:
First:
*
Last:
*
Postal
Address:
*
City:
*
State
/ Province :
*
ZIP
/ Postal Code:
Country:
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier
Islands
Australia
Austria
Azerbaijan
Bahamas, the
Bahrain
Baker Island
Bangladesh
Barbados
Bassas da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burma (Myanmar)
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Democratic
Republic of the Congo
Costa Rica
Croatia
Cuba
Cyprus
Czechia (Czech Republic)
Denmark
Djibouti
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
France
French Guiana
French Polynesia
Gabon Gambia,
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Navassa Island
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestine
Palau
Panama
Papua
New Guinea
Paracel Islands
Paraguay
Peru
Philippines
Austria
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Helena
Samoa
San Marino
Saudi Arabia
Scotland
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wake Island
Wallis and Futuna
West Bank
Yemen
Yugoslavia
Zambia
Zimbabwe
*
Phone:
*
E-mail:
*
Fax:
How
did you find out about Maca Magic Products?
Website
Retail Store
Friend
Other
Please
describe in detail
Business
& Account Experience/ Details:
Business
Name:
*
Business
Phone:
*
Business
Fax:
Business
Address:
*
City:
*
State
/ Province :
*
ZIP
/ Postal Code:
Country:
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier
Islands
Australia
Austria
Azerbaijan
Bahamas, the
Bahrain
Baker Island
Bangladesh
Barbados
Bassas da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burma (Myanmar)
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Democratic
Republic of the Congo
Costa Rica
Croatia
Cuba
Cyprus
Czechia (Czech Republic)
Denmark
Djibouti
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
France
French Guiana
French Polynesia
Gabon Gambia,
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Navassa Island
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestine
Palau
Panama
Papua
New Guinea
Paracel Islands
Paraguay
Peru
Philippines
Austria
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Helena
Samoa
San Marino
Saudi Arabia
Scotland
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wake Island
Wallis and Futuna
West Bank
Yemen
Yugoslavia
Zambia
Zimbabwe
*
Website
url:
Valid
Business License #:
*
Valid
Resellers License #:
*
Valid
Practitioners License #:
Which of our products are you interested in purchasing:
Are
you currently a wholesaler of any products?
If yes, which ones?
Are
you a manufacturer of any products?
If yes, what are they?
What
other brokers, distributors or manufacturers have you worked
with before?
Briefly
describe your plans for marketing Maca Magic Products:
Approximate
volume of Maca Products you foresee handling in your first year?
Do
you attend trade shows, fairs, music, or cultural events?
If yes, which ones?
Applicants
outside of the United States (International)
What
seaport or International airport are you located nearest to?
Have
you ever imported products before?
If so, which ones?
Do
you have the proper paperwork from your country's government
to legally import our products?
If no, what would you need to obtain?
Name
of your Customs Broker:
Broker's Address:
Broker's Phone Number:
Additional
Comments or Questions: