Name (required) Your Email (required) Phone Number (required) Address Occupation Where did you hear about “Sharifah Food”? * Social MediaGoogleReferralOthers Are you going to promote SHARIFAH product from Facebook / Instagram page or any e-commerce channel (e.g. Lazada, Shoppee)? If yes, please indicate them below What do you want to achieve in this agent program? Do you have a personal goal or target? * DECLARATION I hereby declare that the information provided here are true to the best of my knowledge. I am aware that this information’s will be used by SHRF FOOD INDUSTRIES SDN BHD for the purpose of the initial dropship assessment process and for future marketing purposes