NEW
INDEPENDENT MART OWNER ( IMO )
REGISTRATION FORM
Activation Code *
New IMO First Name *
New IMO Last Name *
Birthdate
Cellphone No. *
Email Address *
IMO Sponsor Name*
IMO Sponsor GREENLEAF PH ID NO *
Delivery Information
Full Name of Receiver *
Receiver Contact Number *
House No. & Street (if none, type NONE)
Subdivision/Building Name (if none, type NONE)
Barangay
Town/City
Province
Zip Code
Nearest LBC Branch
Submit
