Customer and Product Submission Form

Name *

Enter the full name of the customer.

This field is required.

Phone *

Enter a valid phone number.

This field is required.

Email *

Enter a valid email address.

This field is required.

Product Information *

Provide details about the product(s). One per line.

This field is required.

Product Name *

Enter the name of the product(s).

This field is required.

Product Link/URL

Provide a link to the product(s) (if applicable). One per line.

This field is required.

Product Description *

Provide a detailed description of the product. Separate by line.

This field is required.

Quantity *

Enter the quantity of the product.

This field is required.

Size / Color / Specifications

Enter product specifications such as size and color. One per line.

This field is required.

How will you reimburse us? *

Select your reimbursement method. An invoice will be placed in your account for payment.

This field is required.

Sourcing Disclaimer

Once Cooriya sources your products and you authorize us to proceed with the purchase, an invoice will be issued to your free Ship2JA.com account. A 50% deposit is required to process all orders, with the remaining 50% due upon delivery to Jamaica. No exceptions.

This field is required.