Dealer Application

Company Details

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*

Contact Person Details

Your Name*

IC Number*

Mobile Number*

Designation*

Email Address*

Attachments
**Please submit BUSINESS CARD / COMPANY PROFILE, FORM D / FORM 9
Business Card*SSM / Business Registration Form*

Note:
*File size limit: 5MB.
**Supported file types: pdf, doc, docx, zip

BELCO

Telephone

Fax

Email

Belco Security Sdn. Bhd.

Operating Hours