Become an Agent

Become an Agent

If you are interested in becoming an Agent for El-Amì, our new cosmetics range, please fill in the online form below. Alternatively you can download & return the form to us by following this link.

New - El-Ami
Our new range of Nourishing Facial Cosmetics contain mostly natural ingredients and have been developed to fight Ageing, Wrinkles and Dehydrated skin. Our Facial Cleansing Bars add additional benefit. Visit for more details.

Online Application Form

Personal Information

Your Full Name

Your Surname

Your Date of Birth

Your Identity Number

Your Home Languages

Address Details

Postal Address I.e PO Box 300, Patensie, Eastern Cape, 6335

Postal code

Street Address

Postal Code

Email & Contact Details

Your Email Address

Your Home Phone Number

Your Work Phone Number

Your Cellphone Number

General Details

Your Occupation

Where do you work?

Are you Married/Single/Divorced?

Your Partner's Full Names

Family Member's Name & Surname

Relationship to Family Member

Family Member's Phone Number

Family Member's Cellphone Number

Have you used El-Amì or Miracle Comfrey Products before?

If Yes, any testimonies?




We care about skin.