Dealer Application

Full Company Name*

Business Registration Number*

GST Number*

Office Telephone*

Office Fax*

Mailing Address*

Market/Business Segment*Total System Integration (SI)Government Tenders & ProjectsInstaller for Residential / CommercialRetail Outlet / ShowroomOriginal Equipment Manufacturer (OEM) / Sub-DistributionOthers:-

Date of Incorporation

Date of Commencement of Business

Authorized Capital

Paid Up Capital

Total No. of Staff

Sales Staff

Technical Staff

Total No. of Branches / Outlets

Branches / Outlets Location

Current Suppliers*

Preferred Brands*

Your Name*

IC Number*

Mobile Number*

Designation*

Email Address*