Philippines DC Application

1. Mail to: Momentum Plus Inc.
1650 S. Amphlett Blvd #226
Momentum San Mateo, CA 94402
Plus
PHILIPPINES DISTRIBUTION CENTER (DC)
APPLICATION
Applicant's Name: ________________________________________ □New Application □Change Request
Spouse’s Name:__________________________________________ MPlus ID#________________
Business Name:__________________________________________ Highest Rank______________
Mailing Address:____________________________________________________________________
Street / Location, City, Province, Country, Postal Code
____________________________________________________________________________________________________________________________
□Home Phone Number___________________________________ □Fax Number___________________________________
□Email:________________________________________________ Country Applying for:_______________________________
(1 per application)
Town, City, Province Applying for:__________________________________________________________________
Placement Placement
Sponsor’s Name:_______________________________________ Sponsor ID #_________________________________
Enrollers Name:_______________________________________ Enroller ID #________________________________
Do you have sufficient funds to purchase 10 VOIP Phones and membership kits to act as inventory in support of others? Please
circle. YES or NO
Do you have a computer with the following capabilities in this location. Please circle.
Internet Access YES NO
Email Access YES NO
MS OFFICE YES NO
MS WORD YES NO
MS EXCEL YES NO
Please rate your ability or the ability of a person on your staff who will handle communications in English. Please circle.
Spoken English Fair Good Excellent
Written English Fair Good Excellent
Understanding English Fair Good Excellent
Payment information
USA Banking Info Philippines Banking Info
Momentum Plus Inc. Lance Lomako
1650 S. Amphlett Blvd #226 San Mateo CA 94402 Banco De Oro
Wellsfargo Bank 343: Ortigas 1- Exchange Road
Account# 160-846-9910
Routing # 121-042-882 Swift Code: BNORPHMM
Peso Account #: 343-012-9324
Payment Via Credit Card (3-4 digits on back of
card)
Credit Card Number:_________________________________________ Exp_______/_______ CVV2__________
Name on Credit Card:_________________________________________ Billing Zip Code:_____________________
I Authorize Momentum Plus to charge my card for the purchase of VOIP products for my DC Inventory.
Signature:____________________________________________________ Date:_______________________