Tech Titan Distribution Credit Application Form

Company Details

Company *

Company Registration No : *

Date of Registration : *

Registered Address *

Business Address *

Office Number *

Please input valid Contact Number : eg. +603XXXXXXXX

Fax Number

Website

Contact Person *

Designation *

Company Officers and Contacts

Managing Director (or equivalent position)

Name *

Mobile Number *

Please input valid Contact Number : eg. +6016XXXXXXXX

Email *

General Manager

Name *

Mobile Number *

Please input valid Contact Number : eg. +6016XXXXXXXX

Email *

Finance Manager

Name *

Mobile Number *

Please input valid Contact Number : eg. +6016XXXXXXXX

Email *

Purchasing Dept

Please input valid Contact Number : eg. +6016XXXXXXXX

Name *

Mobile Number *

Email *

Accounts Payable Dept

Name *

Mobile Number *

Please input valid Contact Number : eg. +6016XXXXXXXX

Email *

Bank Information (Primary) *

Name	Address	Account Number

Other Bank Information

Name	Address	Account Number

Paid Up Capital *

No of Employees *

Years in Business *

Trade Payable Reference *

Company Name	Company Address	Office Number

Other Trade Payable Reference

Company Name	Company Address	Office Number

AMOUNT CREDIT REQUESTED (RM) *

CREDIT TERMS *

Financial Information (Last 2 years)

Year *

Turnover *

Cost of sales *

Net Profit / (Loss) after tax *

(a) Current assets *

(b) Total assets *

(c) Current liabilities *

(d) Total liabilities *

(e) Total Equity *

(b) - (d) = (e) *

Paid-up capital *

Authorised capital *

Trade receivables *

Inventories *

Bank *

Trade payables *

File Attachments

* Total file attachments size cannot be exceed than 20M

Form 24 (CTC Copy within 3 months from to date) *