AYAPA SERVICES LTD

Retailer Exclusive Agreement - Fillable Web Form
Registered office: 2 The Runway, Ruislip, HA4 6SE | Tel: 02072431119

Complete all required fields, tick each declaration, then save or download the completed form.

Unique Form Reference

1. Retailer Details

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Enter valid postcode
Enter valid mobile number
Enter valid email
Enter a valid 9-digit VAT number

2. Agreement Details

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Appointment: The Retailer shall be appointed as an exclusive retailer of AYAPA Products and Services within the agreed territory, subject to compliance with this Agreement and written approval by AYAPA Services Ltd.

3. Products and Services

4. Commission Details

Required

5. Retailer Confirmations *

6. Supporting Documents

Attach or send separately: proof of trading address, VAT certificate, ID, company registration, bank details confirmation, and any additional approval documents requested by AYAPA.

Attach at least one supporting document.

You can select multiple files. When you submit, the completed form and selected attachments will be prepared for email to AYAPA.

    7. Final Declaration and Signature

    By completing and signing this form, the Retailer confirms that the information supplied is true and accurate, they are authorised to enter into this agreement, and they agree to comply with the terms stated above.

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    Sign above using a mouse, stylus, or finger.
    Digital signature is required
    You must confirm this declaration before submitting.

    Complete all required fields and the digital signature, then select Submit. A static PDF copy will be prepared and an email to AYAPA will open. No editable completed HTML copy is downloaded.