Agent Forms

NOTE: All fields are required. This form will not submit if a field is left blank.

Agent Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Enter your Agent Name. Capitalize first letter.

NOTE: If you are not a registered agent you will not be able to access this Form. Please enter your registered agent name as shown on your certification.

The Form will appear below once your Agent Name is confirmed.

Welcome! {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Request Forms

Email Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Enter your email if you want to receive a copy of this order.

Agent Carton Order Form

Customer Details

Complete Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Delivery Information

Delivery Address (Japan) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Carton

Carton Order {binding ItemNumber}

Carton Package

Quantity (Ikutsu) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

How many package? Ex. 1

Deposit (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Price Summary

Total Number of Carton Package {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total Deposit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Sagawa eCollect Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Amount To Pay (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Includes Sagawa eCollect Fee.

Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Delivery

Delivery Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Optional

Agent Pick Up Request Form

Pick Up Information

SENDER & RECIPIENT

CONSIGNOR NAME (Sender) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Pick Up Address (Romaji) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

CONSIGNEE NAME (Recipient) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Delivery Address (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Pick Up Details

Pick Up {binding ItemNumber}

Jumbo Box

Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Enter number of pieces. Ex. 1

No Weight Limit - All Areas

50kg Weight Limit

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Regular Box

50 kg Weight Limit

Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Enter number of pieces. Ex. 1

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Twin Box

100 kg weight limit

Quantity (Set) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Enter number of set. Ex. 1

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Price Summary

Total Number of Boxes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

To be paid by customer to agent.

Total Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

To be paid by agent to Kenshin Hako.

Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Pick Up Schedule

Please see Schedule of Pickup in your area before choosing a date.

Pick Up Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Private Pick Up Areas (No Weight Limit)

Pick Up Truck will arrive at NO SPECIFIC TIME between 8 am - 8 pm on the date you selected.

Reminder {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Instructions

Waiting Or Leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

TAISHITSU: Where is the box exactly located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Other Details {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{~ Payment_Block_Label}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{binding Name}:	{binding displayValue}	---

{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}

Agent Forms

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{binding Name}:	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

Agent Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NOTE: If you are not a registered agent you will not be able to access this Form. Please enter your registered agent name as shown on your certification.

The Form will appear below once your Agent Name is confirmed.

Welcome! {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Request Forms

Email Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Agent Carton Order Form

Customer Details

Complete Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Delivery Information

Delivery Address (Japan) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Carton

Carton Order {binding ItemNumber}

Carton Package

Quantity (Ikutsu) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Deposit (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Price Summary

Total Number of Carton Package {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total Deposit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Sagawa eCollect Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Amount To Pay (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Delivery

Delivery Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Pick Up Request Form

Pick Up Information

SENDER & RECIPIENT

CONSIGNOR NAME (Sender) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Pick Up Address (Romaji) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CONSIGNEE NAME (Recipient) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Delivery Address (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Pick Up Details

Pick Up {binding ItemNumber}

Jumbo Box

Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

No Weight Limit - All Areas

50kg Weight Limit

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Regular Box

Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Twin Box

Quantity (Set) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Price Summary

Total Number of Boxes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Pick Up Schedule

Please see Schedule of Pickup in your area before choosing a date.

Pick Up Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Private Pick Up Areas (No Weight Limit)

Pick Up Truck will arrive at NO SPECIFIC TIME between 8 am - 8 pm on the date you selected.

Reminder {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Instructions

Waiting Or Leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TAISHITSU: Where is the box exactly located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Other Details {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Forms

NOTE: All fields are required. This form will not submit if a field is left blank.

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{binding Name}:	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

Agent Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NOTE: If you are not a registered agent you will not be able to access this Form. Please enter your registered agent name as shown on your certification.

The Form will appear below once your Agent Name is confirmed.

Welcome! {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Request Forms

Email Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Agent Carton Order Form

Customer Details

Complete Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Delivery Information

Delivery Address (Japan) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Carton

Carton Order {binding ItemNumber}

Carton Package

Quantity (Ikutsu) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Deposit (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Price Summary

Total Number of Carton Package {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total Deposit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Sagawa eCollect Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Amount To Pay (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Delivery

Delivery Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Pick Up Request Form

Pick Up Information

SENDER & RECIPIENT

CONSIGNOR NAME (Sender) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Pick Up Address (Romaji) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CONSIGNEE NAME (Recipient) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Delivery Address (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Pick Up Details

Pick Up {binding ItemNumber}

Jumbo Box

Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

No Weight Limit - All Areas

50kg Weight Limit

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Regular Box

Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Twin Box

Quantity (Set) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Price Summary

Total Number of Boxes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Pick Up Schedule

Please see Schedule of Pickup in your area before choosing a date.

Pick Up Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Private Pick Up Areas (No Weight Limit)

Pick Up Truck will arrive at NO SPECIFIC TIME between 8 am - 8 pm on the date you selected.

Reminder {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Instructions

Waiting Or Leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TAISHITSU: Where is the box exactly located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Other Details {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Agent Forms

Request Forms

Agent Carton Order Form

Customer Details

Delivery Information

Carton

Carton Order {binding ItemNumber}

Carton Package

Price Summary

Delivery

Agent Pick Up Request Form

Pick Up Information

SENDER & RECIPIENT

Pick Up Details

Pick Up {binding ItemNumber}

Jumbo Box

Regular Box

Twin Box

Price Summary

Pick Up Schedule

Pick Up Truck will arrive at NO SPECIFIC TIME between 8 am - 8 pm on the date you selected.

Instructions

{~ Payment_Block_Label}

Agent Forms

{{ Cognito.resources['order-transaction-details-header'] }}

Request Forms

Agent Carton Order Form

Customer Details

Delivery Information

Carton

Carton Order {binding ItemNumber}

Carton Package

Price Summary

Delivery

Agent Pick Up Request Form

Pick Up Information

SENDER & RECIPIENT

Pick Up Details

Pick Up {binding ItemNumber}

Jumbo Box

Regular Box

Twin Box

Price Summary

Pick Up Schedule

Pick Up Truck will arrive at NO SPECIFIC TIME between 8 am - 8 pm on the date you selected.

Instructions

Agent Forms

{{ Cognito.resources['order-transaction-details-header'] }}

Request Forms

Agent Carton Order Form

Customer Details

Delivery Information

Carton

Carton Order {binding ItemNumber}

Carton Package

Price Summary

Delivery

Agent Pick Up Request Form

Pick Up Information

SENDER & RECIPIENT

Pick Up Details

Pick Up {binding ItemNumber}

Jumbo Box

Regular Box

Twin Box

Price Summary

Pick Up Schedule

Pick Up Truck will arrive at NO SPECIFIC TIME between 8 am - 8 pm on the date you selected.

Instructions