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eCenter Application Form
     
     
  Individual Applicant
       
  Full Name  
       
  Personal Identification No  
      (Your official Identification Number (ID) recognized by your country. This ID number could be your Passport, Federal ID, Social Security or Social Insurance.)
       
  Citizenship  
       
  Date Of Birth ( DD/MM/YYYY )  
       
  Cosway Stockist Code  
       
  Cosway Membership ID  
       
  eCosway Membership ID  
       
   Corporate Applicant
       
  Company Name  
       
  Company Registration No  
       
  Country of Incorporation  
       

       
  Country of Operation  
       
  Correspondence Address  
     
       
  Zip / Postcode  
       
  City / Town  
       
  State / Province  
       
  Country  
       
Phone Contact No 1 and 2 will be displayed in the List of eCenters. If you do not wish a number to be known to the public, you should not key into these 2 fields.
  Phone Contact No 1   -
       
  Phone Contact No 2   -
       
  Phone Contact No 3   -
       
  Fax No   -
       
  Email Address  
       
  Bank Account No  
       
  Bank Name  
       
  Branch  
       
  Preferred Language  
       
 
eCenter Operator Agreement
Please click on the link below to read the agreement.
 
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I have read the "eCenter Operator Agreement".
 
 
By clicking the "I Accept" button below and submitting this eCenter Operator Agreement, I apply to become an eCenter Operator. I certify that I am of legal age (the age of majority) for the country, state, province, or territory in which I reside. I understand that any intentional misrepresentation of any information I provide on this eCenter Operator Application may result in action by eCosway, up to and including termination of this Agreement. I expressly and affirmatively state and represent that I have had the opportunity to review, and have actually reviewed the eCenter Operator Agreement in its entirety. I further understand and agree that by selecting or clicking on 'I Accept', I will be bound by and will adhere to the Terms and Conditions in the eCenter Operator Agreement. I understand that I have the right to terminate the eCenter Operator Agreement by serving seven (7) working days notice, with or without reason. I agree that such termination must be in writing.

I understand that the Company reserves the right to approve or reject my application without assigning any reason thereto.
 

 


     
   
     
   
   

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