{"id":258,"date":"2026-09-12T06:37:51","date_gmt":"2026-09-11T23:37:51","guid":{"rendered":"https:\/\/nusavaya.com\/?page_id=258"},"modified":"2026-09-12T06:38:41","modified_gmt":"2026-09-11T23:38:41","slug":"supplier-form","status":"publish","type":"page","link":"https:\/\/nusavaya.com\/id\/supplier-form\/","title":{"rendered":"Supplier Form"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"258\" class=\"elementor elementor-258\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-146b9a5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"146b9a5\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-34d2f7a\" data-id=\"34d2f7a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2ac5aeb elementor-widget elementor-widget-shortcode\" data-id=\"2ac5aeb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">    <style>\n      @import url('https:\/\/fonts.googleapis.com\/css2?family=Nunito:wght@400;600;700;800&display=swap');\n\n      .nusavaya-form-container {\n        font-family: 'Nunito', sans-serif;\n        background: #ffffff;\n        border: 1px solid #d8ece0;\n        border-radius: 20px;\n        padding: 40px;\n        max-width: 900px;\n        margin: 0 auto;\n        box-shadow: 0 8px 30px rgba(27, 77, 62, 0.05);\n        box-sizing: border-box;\n      }\n      .nusavaya-form-header { margin-bottom: 28px; }\n      .nusavaya-form-title { font-size: 28px; font-weight: 800; color: #1B4D3E; margin: 0 0 10px 0; }\n      .nusavaya-form-desc { font-size: 15px; color: #384A41; line-height: 1.6; margin: 0; }\n      \n      .nusavaya-form-grid { display: grid; grid-template-columns: repeat(2, 1fr); gap: 18px; }\n      .nusavaya-form-full { grid-column: span 2; }\n      @media (max-width: 768px) { .nusavaya-form-grid { grid-template-columns: 1fr; } .nusavaya-form-full { grid-column: span 1; } }\n\n      .nusavaya-field-group { display: flex; flex-direction: column; gap: 6px; }\n      .nusavaya-field-group label { font-size: 13.5px; font-weight: 700; color: #1B4D3E; }\n      .nusavaya-field-group label .req { color: #00C853; margin-left: 2px; }\n      .nusavaya-input, .nusavaya-select, .nusavaya-textarea {\n        width: 100%; height: 44px; padding: 0 14px; border: 1.5px solid #d8ece0; border-radius: 8px;\n        font-family: 'Nunito', sans-serif; font-size: 14px; color: #1B4D3E; background: #f4faf6;\n        box-sizing: border-box; transition: all 0.3s ease;\n      }\n      .nusavaya-textarea { height: 100px; padding: 12px 14px; resize: vertical; }\n      .nusavaya-input:focus, .nusavaya-select:focus, .nusavaya-textarea:focus {\n        outline: none; border-color: #00C853; background: #ffffff; box-shadow: 0 0 0 3px rgba(0, 200, 83, 0.15);\n      }\n      .nusavaya-helper { font-size: 11.5px; color: #6b8275; margin: 0; }\n\n      .nusavaya-options-grid { display: grid; grid-template-columns: repeat(2, 1fr); gap: 8px; background: #f4faf6; padding: 12px 14px; border-radius: 8px; border: 1.5px solid #d8ece0; }\n      @media (max-width: 600px) { .nusavaya-options-grid { grid-template-columns: 1fr; } }\n      .nusavaya-option-item { display: flex; align-items: center; gap: 8px; font-size: 13px; color: #384A41; cursor: pointer; }\n      .nusavaya-option-item input { accent-color: #00C853; width: 16px; height: 16px; margin: 0; cursor: pointer; }\n\n      .nusavaya-submit-btn {\n        background-color: #1B4D3E; color: #ffffff; height: 48px; border: none; border-radius: 8px;\n        font-size: 15px; font-weight: 800; cursor: pointer; transition: all 0.3s ease; width: 100%; margin-top: 10px;\n      }\n      .nusavaya-submit-btn:hover { background-color: #00C853; box-shadow: 0 6px 18px rgba(0, 200, 83, 0.3); }\n\n      .nusavaya-alert-error { background: #ffebee; color: #c62828; border: 1px solid #ef9a9a; padding: 14px; border-radius: 8px; margin-bottom: 20px; font-size: 14px; font-weight: 700; }\n      .nusavaya-success-box { background: #e8f8ee; border: 1.5px solid #00C853; border-radius: 16px; padding: 36px; text-align: center; }\n      .nusavaya-success-title { font-size: 24px; font-weight: 800; color: #1B4D3E; margin: 12px 0 8px 0; }\n      .nusavaya-success-desc { font-size: 15px; color: #384A41; line-height: 1.6; margin: 0; }\n    <\/style>\n\n    <div class=\"nusavaya-form-container\">\n              <div class=\"nusavaya-form-header\">\n          <h2 class=\"nusavaya-form-title\">Menjadi Mitra Suplai<\/h2>\n          <p class=\"nusavaya-form-desc\">\n            Are you an Indonesian producer, processor, artisan business or manufacturer with products that may be suitable for wider markets? Tell us about your company and products for an initial Nusavaya review.\n          <\/p>\n        <\/div>\n\n        \n        <form method=\"POST\" action=\"\" enctype=\"multipart\/form-data\" data-trp-original-action=\"\">\n          <input type=\"hidden\" id=\"nusavaya_supplier_nonce\" name=\"nusavaya_supplier_nonce\" value=\"12b4b2cf63\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/id\/wp-json\/wp\/v2\/pages\/258\" \/>          \n          <div class=\"nusavaya-form-grid\">\n            \n            <div class=\"nusavaya-field-group\">\n              <label>Company \/ Business Name <span class=\"req\">*<\/span><\/label>\n              <input type=\"text\" name=\"supplier_company\" class=\"nusavaya-input\" required value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>Brand Name<\/label>\n              <input type=\"text\" name=\"supplier_brand\" class=\"nusavaya-input\" placeholder=\"Optional\" value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>Contact Person <span class=\"req\">*<\/span><\/label>\n              <input type=\"text\" name=\"supplier_contact\" class=\"nusavaya-input\" required value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>Role \/ Position<\/label>\n              <input type=\"text\" name=\"supplier_role\" class=\"nusavaya-input\" placeholder=\"Optional\" value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>Email <span class=\"req\">*<\/span><\/label>\n              <input type=\"email\" name=\"supplier_email\" class=\"nusavaya-input\" required value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>Phone \/ WhatsApp <span class=\"req\">*<\/span><\/label>\n              <input type=\"tel\" name=\"supplier_phone\" class=\"nusavaya-input\" placeholder=\"+62...\" required value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>City \/ Province <span class=\"req\">*<\/span><\/label>\n              <input type=\"text\" name=\"supplier_location\" class=\"nusavaya-input\" placeholder=\"e.g. Surabaya, East Java\" required value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>Website \/ Instagram<\/label>\n              <input type=\"text\" name=\"supplier_web\" class=\"nusavaya-input\" placeholder=\"Optional link or handle\" value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Product Category <span class=\"req\">*<\/span><\/label>\n              <select name=\"supplier_category\" class=\"nusavaya-select\" required>\n                <option value=\"\">Select Category<\/option>\n                <option value=\"Natural Ingredients\">Bahan Alami<\/option>\n                <option value=\"Food & Spices\">Makanan &amp; Rempah-rempah<\/option>\n                <option value=\"Home Decor & Living\">Dekorasi Rumah &amp; Perlengkapan Rumah<\/option>\n                <option value=\"Other\">Other<\/option>\n              <\/select>\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Main Product(s) <span class=\"req\">*<\/span><\/label>\n              <textarea name=\"supplier_products\" class=\"nusavaya-textarea\" required placeholder=\"List key products you offer...\"><\/textarea>\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Short Product Description <span class=\"req\">*<\/span><\/label>\n              <textarea name=\"supplier_description\" class=\"nusavaya-textarea\" required placeholder=\"Keep description concise...\"><\/textarea>\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>Main Raw Material \/ Origin<\/label>\n              <input type=\"text\" name=\"supplier_origin\" class=\"nusavaya-input\" placeholder=\"Optional\" value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group\">\n              <label>Indicative Monthly Capacity<\/label>\n              <input type=\"text\" name=\"supplier_capacity\" class=\"nusavaya-input\" placeholder=\"e.g. 5 Tons\/month\" value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Current Market<\/label>\n              <div class=\"nusavaya-options-grid\">\n                <label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_market[]\" value=\"Local Indonesia\"> Local Indonesia<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_market[]\" value=\"National Indonesia\"> National Indonesia<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_market[]\" value=\"Export\"> Export<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_market[]\" value=\"Not yet commercially active\"> Not yet commercially active<\/label>              <\/div>\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Have you exported before?<\/label>\n              <div class=\"nusavaya-options-grid\" style=\"grid-template-columns: repeat(2, 1fr);\">\n                <label class=\"nusavaya-option-item\"><input type=\"radio\" name=\"supplier_exported\" value=\"No\" checked onclick=\"document.getElementById('export_countries_wrapper').style.display='none';\"> No<\/label>\n                <label class=\"nusavaya-option-item\"><input type=\"radio\" name=\"supplier_exported\" value=\"Yes\" onclick=\"document.getElementById('export_countries_wrapper').style.display='flex';\"> Yes<\/label>\n              <\/div>\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\" id=\"export_countries_wrapper\" style=\"display:none;\">\n              <label>Previous Export Country \/ Countries<\/label>\n              <input type=\"text\" name=\"supplier_export_countries\" class=\"nusavaya-input\" placeholder=\"e.g. Japan, USA, Malaysia\" value=\"\">\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Documents \/ Certifications Currently Held<\/label>\n              <div class=\"nusavaya-options-grid\">\n                <label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"NIB \/ Business Legality\"> NIB \/ Business Legality<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"Halal\"> Halal<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"BPOM \/ PIRT\"> BPOM \/ PIRT<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"HACCP\"> HACCP<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"ISO\"> ISO<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"Organic\"> Organic<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"Food Safety Certification\"> Food Safety Certification<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"Laboratory Test\"> Laboratory Test<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"Other\"> Other<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_docs[]\" value=\"Not yet available\"> Not yet available<\/label>              <\/div>\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Main Challenge Today<\/label>\n              <div class=\"nusavaya-options-grid\">\n                <label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Finding buyers\"> Finding buyers<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Product readiness\"> Product readiness<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Quality\"> Quality<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Certification \/ Compliance\"> Certification \/ Compliance<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Packaging\"> Packaging<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Export documentation\"> Export documentation<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Production capacity\"> Production capacity<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Pricing\"> Pricing<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Export knowledge\"> Export knowledge<\/label><label class=\"nusavaya-option-item\"><input type=\"checkbox\" name=\"supplier_challenge[]\" value=\"Other\"> Other<\/label>              <\/div>\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Short Message<\/label>\n              <textarea name=\"supplier_message\" class=\"nusavaya-textarea\" placeholder=\"Optional notes...\"><\/textarea>\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label>Company \/ Product Deck (Optional)<\/label>\n              <input type=\"file\" name=\"supplier_upload\" class=\"nusavaya-input\" style=\"padding-top:8px;\" accept=\".pdf,.doc,.docx,.xlsx,.jpg,.png\">\n              <p class=\"nusavaya-helper\">Upload only non-confidential material requested for initial review (PDF, DOCX, XLSX, JPG, PNG).<\/p>\n            <\/div>\n\n            <div class=\"nusavaya-field-group nusavaya-form-full\">\n              <label class=\"nusavaya-option-item\" style=\"align-items:flex-start; gap:10px;\">\n                <input type=\"checkbox\" name=\"supplier_consent\" value=\"1\" required style=\"margin-top:3px;\">\n                <span style=\"font-size:13px; line-height:1.5;\">I confirm that the information provided is accurate to the best of my knowledge and may be used by Nusavaya for initial internal evaluation. <span class=\"req\">*<\/span><\/span>\n              <\/label>\n            <\/div>\n\n            <div class=\"nusavaya-form-full\">\n              <button type=\"submit\" name=\"nusavaya_supplier_submit\" class=\"nusavaya-submit-btn\">Submit Supplier Profile<\/button>\n            <\/div>\n\n          <\/div>\n        <input type=\"hidden\" name=\"trp-form-language\" value=\"id\"\/><\/form>\n          <\/div>\n    <\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-258","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/nusavaya.com\/id\/wp-json\/wp\/v2\/pages\/258","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nusavaya.com\/id\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/nusavaya.com\/id\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/nusavaya.com\/id\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nusavaya.com\/id\/wp-json\/wp\/v2\/comments?post=258"}],"version-history":[{"count":3,"href":"https:\/\/nusavaya.com\/id\/wp-json\/wp\/v2\/pages\/258\/revisions"}],"predecessor-version":[{"id":261,"href":"https:\/\/nusavaya.com\/id\/wp-json\/wp\/v2\/pages\/258\/revisions\/261"}],"wp:attachment":[{"href":"https:\/\/nusavaya.com\/id\/wp-json\/wp\/v2\/media?parent=258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}