Ikhtiar Engineering Sdn Bhd (IESB)

Dealer & Distributor Application Form

... Thank you for your interest in becoming a Dealer and/or Distributor of our products. We look forward to doing business with you....

All fields in this form must be filled out completely in order to recieve samples and pricing information. All information will be treated as confidential and used solely for the purpose of determining how we may best serve your account. Fields in yellow are required.

I'm Interested in becoming a (choose one):
Touch & Log Distributor	Touch & Log Dealer
Company Name:
Contact Person :
Designation:
Address:
Telephone:
Fax:
Email:
Number of Years in the Services Business: year(s)
Customer Locations (list countries):
How Much of Your Business is Related to Security Management System (%):
Describe Your Company (choose one):
Trading Company	Installer
Regional Distributor	Retailer
National Distributor

Trade Reference 1 -
Company Name:
Contact Person:
Fax Number:

Bank Reference 1 -
Company Name:
Account Number:
Fax Number:
Thank you for completing this questionnaire. Please click the button below to send the information.