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Company/Member Name
Comp Reg No or IC/Passport No
Email
Contact No
Password (Min. 6 characters)
Confirmed Password
Address
Postcode
City
State
Johor
Kedah
Kelantan
Kuala Lumpur
Melaka
Negeri Sembilan
Pahang
Perak
Perlis
Pulau Pinang
Selangor
Terengganu
Country
West Malaysia
East Malaysia
Singapore
Sales Consultant
-- Select --
IVAN TAY
JAMES NG
JOHNNY TAY
LESLEY TAY
MR LEE
Type of Business
P. Incharge Name
P. Incharge 2 Name
PIC Contact No
PIC 2 Contact No
PIC Gender
PIC 2 Gender
PIC Position
PIC 2 Position
PIC Email
Our Bank Account Info
Bank Name:
RHB BANK
Account Holder Name:
WINSERN LABELGRAPHIC SDN BHD
Account No:
2070 9100 0180 72
Top Up Amount
RM
Min: RM100
Remarks
Bank Name
Bank Reference No
Payment Document
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