Agent Forms

NOTE: All fields are required. This form will not submit if a field is left blank.
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Enter your Agent Name. Capitalize first letter.

InOut OutIn
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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.

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Request Forms

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

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Agent Carton Order Form

Customer Details

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

Carton Order {binding ItemNumber}
Carton Package
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How many package? Ex. 1

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Price Summary

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

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Delivery

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Optional

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Agent Pick Up Request Form

Pick Up Information

SENDER & RECIPIENT
CONSIGNOR NAME (Sender) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Pick Up Address (Romaji) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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CONSIGNEE NAME (Recipient) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Delivery Address (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Pick Up Details
Pick Up {binding ItemNumber}
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Jumbo Box
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Enter number of pieces. Ex. 1

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Choose your Prefecture

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Provincial Charge

No Weight Limit - All Areas

50kg Weight Limit

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Regular Box

50 kg Weight Limit

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Enter number of pieces. Ex. 1

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Provincial Charge

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Twin Box

100 kg weight limit

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Enter number of set. Ex. 1

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Provincial Charge

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Price Summary
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To be paid by customer to agent.

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To be paid by agent to Kenshin Hako.

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

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

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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.

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Instructions
Waiting Or Leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Other Details {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{~ 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-transaction-details-header'] }}

{{ 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}
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Go! {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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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 }
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Request Forms

Choose Form {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Email Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Agent Carton Order Form

Customer Details

Complete Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Network {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Delivery Information
Delivery Address (Japan) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Carton

Carton Order {binding ItemNumber}
Carton Package
Choose Package {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Quantity (Ikutsu) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Deposit (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Price Summary

Total Number of Carton Package {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Total Deposit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Sagawa eCollect Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Amount To Pay (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Delivery

Delivery Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Delivery Time {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Agent Pick Up Request Form

Pick Up Information

SENDER & RECIPIENT
CONSIGNOR NAME (Sender) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Network {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Pick Up Address (Romaji) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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CONSIGNEE NAME (Recipient) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Delivery Address (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Pick Up Details
Pick Up {binding ItemNumber}
Type Of Box {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Jumbo Box
Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Prefecture (Ken) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Destination (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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No Weight Limit - All Areas

50kg Weight Limit

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Regular Box
Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Destination (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Twin Box
Quantity (Set) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Destination (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
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Price Summary
Total Number of Boxes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Total Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Total Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ 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}
{ binding firstError.message }
Pick Up Time {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ 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 }
{ binding firstError.message }
Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Instructions
Waiting Or Leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
TAISHITSU: Where is the box exactly located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other Details {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Agent Forms

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

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

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

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 }
{ binding firstError.message }

Request Forms

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

Agent Carton Order Form

Customer Details

Complete Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Network {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Delivery Information
Delivery Address (Japan) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Carton

Carton Order {binding ItemNumber}
Carton Package
Choose Package {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity (Ikutsu) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Deposit (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Price Summary

Total Number of Carton Package {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Total Deposit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Sagawa eCollect Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Amount To Pay (COD) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Delivery

Delivery Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Delivery Time {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ 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}
{ binding firstError.message }
Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Network {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Pick Up Address (Romaji) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
CONSIGNEE NAME (Recipient) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Delivery Address (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Pick Up Details
Pick Up {binding ItemNumber}
Type Of Box {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Jumbo Box
Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Prefecture (Ken) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Destination (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

No Weight Limit - All Areas

50kg Weight Limit

Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Regular Box
Quantity (Pcs) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Destination (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Twin Box
Quantity (Set) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Destination (Philippines) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Remote Area Charge {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Price Summary
Total Number of Boxes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Total Retail Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Total Agent Price {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Payment Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Amount To Pay {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ 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}
{ binding firstError.message }
Pick Up Time {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ 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 }
{ binding firstError.message }
Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Instructions
Waiting Or Leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
TAISHITSU: Where is the box exactly located? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Other Details {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Note {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }