Product Application Form

1 Applicant
2 Product & Payment
3 Shipping & Agreement

Application Type

User / End Customer

I am purchasing a machine for personal use

Direct Seller

I am registering as a direct seller (requires KTP & bank account)

Applicant Information

Full Name *

ID Number / Company * National ID (KTP) for individuals, or company registration for businesses

Date of Birth Applicant must be 18 years or older

Gender

Full Address *

City *

Postal Code *

Phone

Mobile Phone *

Email *

Select	Product	Price per Unit	Serial Number
	SD501 — Leveluk SD501	Rp 44.000.000
	JR IV — Leveluk JR IV	Rp 30.000.000
	SD501-PT — Leveluk SD501-PT	Rp 47.800.000
	SUPER 501 — Leveluk Super 501	Rp 62.400.000
	ANESPA DX — Anespa DX	Rp 32.000.000
	K8 — Leveluk K8	Rp 58.000.000
	SD 501 DX — Leveluk SD501 DX	Rp 55.000.000
	emGuarde — emGuarde	Rp 22.800.000
	Kangen Air — Kangen Air	Rp 21.000.000

Shipping Address

Same as applicant address

Recipient *

Recipient Phone *

Shipping Address *

City *

Postal Code *

Agreement & Acknowledgments

I agree that I have received a copy of the Direct Seller guidebook and have read, and agree to the terms and conditions applicable at PT. ENAGIC INDONESIA. The Direct Seller and Applicant declare and warrant that the Applicant is a male or female Indonesian citizen who is eighteen (18) years of age or older. The Direct Seller and Applicant declare and warrant that all information provided to PT. ENAGIC INDONESIA is complete and accurate.

1. Reselling packaged water produced by Enagic machines is prohibited by law. Violations may result in legal consequences. 2. Opening the machine or receiving services such as deep cleaning or repairs from third-party providers other than official PT. ENAGIC INDONESIA branches may result in warranty cancellation. 3. Soliciting another team\'s network is prohibited and may result in sanctions, as regulated in the PT. ENAGIC INDONESIA Code of Ethics. 4. Offering discounts without PT. ENAGIC INDONESIA approval is prohibited. Violations will result in a warning letter, suspension, or revocation of direct seller ID. 5. Selling Enagic machines through any online marketplace or e-commerce platform is prohibited. Violations will result in sanctions as regulated in the Code of Ethics.

Sign using your mouse, trackpad, or touchscreen