Member Information
*Company Name:
*Date Incorporated: / / DD/MM/YYYY
*Registry of Companies ID No:
*Type of Business:

Sole Proprietary
Private Company
Partnership
Limited Company

*Desired Payment Modes Direct Debit Authorisation
Giro-On-Demand
Cheques
Bank Draft
Telegraphic Transfer
Letter of Credit
*GST Registration:
Member Contact Person Information
*Contact Person Name:
*Contact Person NRIC:
*Contact Person Appointment:
*Telephone Number:
*Fax Number:
E-Mail Address:
Member Contact Person Information No.2 Same as above  
Contact Person Name:
Contact Person NRIC:
Contact Person Appointment:
Telephone Number:
Fax Number:
E-Mail Address:
Corporate Address/Billing Address
*Address:
*Zip/Postal code:
*City/State:
*Country:
*Tel:
Fax:
Shipping Address Same as Corporate/Billing Address
Address:
Zip/Postal code:
City/State:
Country:
Tel:
Fax:
Others
Website of Retailer: http://
Brief Descirption:

*Compulsary fields
Note:Copies of your NRIC or Passport will be required for official purposes, Eye-Biz will contact you to finalise the details.
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