FORM — White Label & Order (Diaspora)
SECTION 1 — Personal Information
Full Name
*
Email Address
*
WhatsApp Number (with country code)
*
Expected format: +2376... (starts with + and country code, 6–15 digits)
Country of Residence
*
-- Select a country --
Canada
United States
United Kingdom
France
Belgium
Germany
Switzerland
Other (please specify)
Are you?
*
Individual
Business / Reseller
Company (with tax number)
SECTION 2 — Type of Request
White Label / Private Label
Purchase of ready-to-use products (EVEN FOOD)
Become a distributor / pickup point
SECTION 3 — Project Details (White Label)
Desired products:
Tomato Powder
Smoked Fish
Dry Chili / Powder
Ginger Powder
Organic Seasoning Cube
Other (please specify)
Desired Quantity (first batch)
Packaging format
Transparent Kraft Bags
Metalized Bags
Jars / Pots
I want a proposal
Do you already have a logo?
Yes (I will upload it)
No (I want a design)
Upload Logo (png, jpg, svg)
Text to display on packaging (if ready)
Expected launch date
Urgent (less than 15 days)
Normal (15–30 days)
Flexible
SECTION 4 — Order Details (Existing Products)
Desired products:
Is this purchase for:
Personal consumption
Resale in my country
Delivery method:
Home delivery
Pickup point
SECTION 5 — Shipping & Payment
Full delivery address
Preferred payment method:
Mobile Money (MTN / Orange)
Credit Card (Visa / Mastercard)
PayPal
Other
Additional information
I agree to be contacted via WhatsApp and email to finalize my request.
SUBMIT MY REQUEST
Thank you! Your request has been sent. We will contact you within 24h via WhatsApp.