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Dealership Application Form (LogOn)

Please provide the following information:

Company/Business Name
Street Address
Address (cont.)
City
State
Postal Code
Phone
FAX
E-mail
URL

TYPE OF BUSINESS
LIMITED LIABILITY COMPANY SOLE PROPRIETORSHIP
RC Number
Date Issued
Authorized Capital
Subscribed Capital
Paid-up Capital
Annual Turnover for last two years
Document Required
  • Copy of Registration Certificate
  • Company Profile

COMPANY OFFICERS ( Amend Titles as appropriate)
Managing Director Marketing Manager
General Manager Accountant

BOARD OF DIRECTORS

Name

Residential Address

 Telephone Number

BANKERS

Bank Name

Branch

Phone No.

Account No.

SIMILAR PRODUCTS DEALING IN

Products

Company

Terms and Conditions:

  1. The dealer is expected t make full payment on transaction
  2. "Dealership Agreement" will only be given after submitting the proper documents and after verification of claims made
  3. Delivery time shall depend on the availability of stock
  4. All sales are final.

By Clicking the submit form button below, I certify that all information provided above are true and correct. I hereby authorize PINET Informatics to perform the necessary investigation of the above information.

Name :

Position:



 
 
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Dealers Application Form
 

 
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