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Dealer Application Form
Please complete this Dealer Application Form and click on the SUBMIT button to submit your application.
COMPANY / BUSINESS PARTICULARS
Company Name
Date of Incorporation Business Registration No:
Business Address
Company URL Email
Phone Fax
Contact Person Designation
Type of Organisation Proprietorship Partnership Private Limited Others
Related Company (s)
(If any) Paid-up Capital
Principle Business Activities IT Retailer System Integrator SupplierAV Retailer
 StationerySchoolOffice Automation Others, please specify
Number of Staff Currently Employed Approx. Annual Sales Turnover
PARTICULARS OF SHAREHOLDER / DIRECTOR / PARTNER / PROPRIETOR

Name

I/C Number

Residential Address

Designation

Share %
TYPE OF PRODUCTS CURRENTLY MARKETED / SOUCE

Product Name

Brand/Model

Value/Quantity

Supplier
PRODUCTS INTERESTED IN:
BOSCH - Conference Systems SANYO
SAMSUNG - Visualise/Video presenter CHIAYO - Portable Wireless Amplifiers
DRAPER - Projection Screen AVA DISPLAY - Interactive LCD
AVERVISION - Digital Document Presenter TOPLINE - AV Trolley, Laser Pointer, Flipchart

© 2007 Hayamim Ava Sdn Bhd
 

Member of The International Communications Industries Association
Kementerian Kewangan Malaysia / E-perolehan (357-00036571)

Showroom Address: Lot 27, Jalan SBC 5, Taman Sri Batu Caves Industrial Park, 68100 Batu Caves, Selangor, Malaysia
Telephone: +603 6189 3213 (Hunting) +603 6189 1197 Fax: +603 6189 1200
Email sales@hayamim.com.my