PART 1: Product Claiming Details

Note: After sending your Payment, please fill-up the form below with accurate information.

Your Complete Name
(Your First and Last Name)

Your Email Address
(Submit an Active Email Address)

Your Cellphone Number
(Submit a Unique, Valid and Active Cellphone Number)

Your Complete Address for Delivery
(Indicate LBC Express Branch if for PICK-UP)

Country

Zip or Postal Code

PART 2: Proof of your Payment

Note: For us to verify your Payment for the Surich Team Membership Fee. You need to submit the Proof of your Payment below.

Purchased Package
Re-Order: 5 Sets Surich PackageRe-Order: 10 Sets Surich PackageRe-Order: 15 Sets Surich PackageSurich Stockist Package

Total Amount Paid

Payment Method Used
BDOBPIGlobe GCashLBC Pera PadalaMetrobankPalawan ExpressUnionbankEon AccountWestern Union

Submit your Proof of Payment here
*we accept photo of receipt, deposit slip or screenshot of payment
*it must be clear and readable
*click "Choose File" button below to upload your proof of payment

*or you can simply enter your payment verification details below
*see sample payment verification details here

Note: Please review ALL the details you have provided above before clicking the Submit Button below. Once you clicked the Submit Button, the details and information you have provided above will be considered Final and Unchangeable.

Image Verification
(Write the image seen below at the space provided)

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