Business in a box Registration Please complete the short form below and choose how you would like to pay for your Tester kit "Business in a box"Name* Name Surname Email* Mobile No.*Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Where did you hear about PAPILLON (please select an option)*Google searchFacebookInstagramWere you referred by an existing Papillon Agent?*YESNOPlease provide the referring Agent's details. First Last Are you employed*YESNOChoose your startup option*Large Starter pack (R700)Medium Starter pack (R350)Small Starter pack (R150) Large Starter Pack- A stylish silver cosmetic case and material drawstring bag. - A fragrance list and Pure Skin info guide.- 69 x 5ml atomizers/testers for skin testing on customers. (All fragrances in the Papillon range)- 50 anonymous business cards to promote your business & ensure that customers contact you for repeat orders.- An order/receipt book to keep track of your orders, payments and customer's information.- 1 branded pen to record orders.- 1 book of 100 smelling strips – if customers don’t want to test fragrances on their skin.- Container with coffee beans – for customers to neutralize their sense of smell when testing different fragrances. Medium Starter Pack- 2 material drawstring bags. - A fragrance list and Pure Skin info guide. - 30 x 5ml atomizers/testers for skin testing on customers. (Top - 20 Female Fragrances & Top 10 Male Fragrances).- 1 book of 100 smelling strips – if customers don’t want to test fragrances on their skin.Expand your kit to the full range as your business grows! Small Starter Pack- 1 material drawstring bag.- A fragrance list info guide.- 15 x 5ml atomizers/testers for skin testing on customers. (Top - 15 Female Fragrances & Top 5 Male Fragrances).Expand your kit to the full range as your business grows!Home Address InformationAddress information is needed for delivery purposes.Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweHome Address*Address information is needed for delivery purposes. PLEASE provide as much info as possible so that the courier can find you easily and to avoid delays! Home address Line 1 Home address Line 2 City / Town Province Postal Code Work Address InformationAddress information is needed for delivery purposes. PLEASE provide as much info as possible so that the courier can find you easily and to avoid delays!Work address Line 1* Work address Line 1 Work address Line 2 City / Town where you live Province Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Payment OptionsPAPILLON uses PayFast, a 100% secure online payment platform.Would you like to pay now for your Tester kit using any of payment options available:*Yes, show me the payment options.No I am hesitant to make a payment now.If you selected No above, please provide a reason.*I bank with:*ABSA, FNB, Nedbank, Standard BankCapitecI do not have a bank accountOtherHow would you like to pay for your Starter Pack?* MasterCard/Visa Credit CardMasterPassManual EFT/ Bank DepositHow would you like to pay for your Starter Pack*Global1 Credit CardManual EFT/ Bank DepositIn the unlikely event that your Global 1 card is not registered for online shopping (almost all are), please contact your nearest Capitec branch to activate it. How would you like to pay for your Starter Pack?*Manual EFT/ Bank DepositPaying via Manual EFT / Bank Deposit -You have 48 hours to pay and send us proof of payment.-If you don't pay in time, we'll cancel the order on your behalf.-Orders placed after hours, on weekends or public holidays will be processed the following business day.Step 1 Please EFT or make a Bank deposit to: Papillon (Pty) LtdFNB Checque account 62454783830Branch code 260231Use your Name and Surname as reference Step 2 Please submit proof of payment to info@papillon.co.zaNameThis field is for validation purposes and should be left unchanged.
