Application Form

Welcome to secure online form where you can apply to become a distributor in just three steps. This page as well the transmission of the information is fully encrypted with the latest 128-bit encryption technology.

Your information will be treated at the utmost confidentiality by Kenrico and will only be used to process your distributorship application as regulated by ISO 9001:2008 and Japanese commerce law.

Step 1 Your company information
The information that you provide below must match your company registration document. We may ask you to provide us your company registration document if you are a company or a copy of your identification card, passport or driver license if you are an individual applicant without a company.

Required Your full name:
Your full name as in your ID or passport
Position in your company:
Board member / director / etc
Company name:
Your legally registered company name
Company registration number:
Reg number / Tax ID / VAT ID
Date of incorporation:
The establishment date of your company
Number of years in business:
Enter 1 for recently registered company
Required Company address:
Must be physical address 12
1 PO BOX not accepted
2 Forwarding address not accepted
Required Country:
Select from the drop-down menu
Required Phone number:
Landline or cellular phone number
Fax number:
Facsimile number
Required Email address:
Enter your email address twice

Enter your email address

Enter the same email address again for confirmation
Website address:
Domain name of your company

Step 2 More information
The information that you provide below is essential to determine the success of your distributorship application of being accepted. Please take the time to ensure that you provide us the most complete and accurate information.

Required From where did you hear about us?
Which one(s) of our products that you are interested in reselling or distribution?
Check one or more boxes
Kenrico Sap Sheet
Kenrico Diamond Hybrid Edition DHE
Kenrico Carbon Titanium CT
Kenrico Mini Water Filter
Kenrico Ion Water Purifier GOLD
Kenrico Ion Water Purifier SILVER
Kenrico Ion Shower Head LE
Kenrico Ion Shower Head EX
Kenrico Forever Alkaline Water Stick NX-2
Required Are you interested in co-branding?
Your commercial brand developed by Kenrico
Required Are you interested in exclusivity?
Exclusivity has higher order requirement
What motivates you to become Kenrico Distributor?
Your reason of joining Kenrico
Any questions or comments?
Your questions about distributorship

Step 3 Enter your application number
Review the legal statements below before you apply for distributorship.
By submitting this form, I understand that this is not an automatic approval of my distributorship. Furthermore, I understand that my distributorship can only commence once the first order is made by me and the legal agreement are signed by me and Kenrico.

By submitting this form, I certify that the information provided on this request is valid and complete. Kenrico is authorized to conduct an investigative report / inquiry that is deemed necessary in order to verify the accuracy of this information, and, to determine my credit worthiness. I understand that I may be asked to provide business registration documents and other documents to Kenrico for verification.

Enter your application number shown on the left