MIWACLUB Authorized Seller Registration Form

Kindly register your store (Offline & Online store) with us as “Authorized Seller Store”, so that your customers are eligible to collect points with the purchases of Dale & Cecil’s products from your store.

    Part 1: Company & Person-In-Charged Information

    Company Name

    Person-In-Charged's Name

    Person-In-Charged's Email

    Person-In-Charged's Contact Number

    Part 2: Physical Store Information

    How many physical stores do you have?

    Physical Store Name (1)

    Physical Store Full Address (1)

    Physical Store Name (2)

    Physical Store Full Address (2)

    Physical Store Name (3)

    Physical Store Full Address (3)

    List down your physical store's name & full address here if you have more than 3 outlets.

    Part 3: Online Store Information

    How many online stores do you have?

    Upload your online store's logo in JPG or PNG Format.

    Online Store Name (1)

    Online Store Platform (1)

    Online Store Link (1)

    Online Store Name (2)

    Online Store Platform (2)

    Online Store Link (2)

    Online Store Name (3)

    Online Store Platform (3)

    Online Store Link (3)

    List down your online store's name, platform & link here if you have more than 3 outlets.

    Part 4: My Service Agent

    My Service Agent

    My Service Agent's Contact Number

    Part 5: Dale & Cecil's Products

    Which product that your stores / shops sell?


    Kindly wait for 5 - 10 seconds after click "submit" button.

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