Membership Application Form

Agent / Membership Registration

To apply for membership please complete all questions. Your membership application is subject to our approval. We reserve the right to reject your membership application for any reason, including if we suspect that any information provided to us is false.
Member Identity*

IndividualBusiness
E-mail
Billing Info
Company / Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Reg. No.*
If Individual just fill in NONE
GST Reg. No.*
If Individual just fill in NONE
Tel No.*

Area CodePhone Number
Fax No.

Area CodePhone Number
Person in-charged*
Preferred Delivery Method*

DeliverySelf Collect
Personal Info
Full Name*
NRIC*
990919-09-9999
Race*
Mobile No.*

Area CodePhone Number
Website
Skype
Please proof check the email address you have entered. This is the email address we will send your registration confirmation.
Once you submit your registration mean you consent to the Membership Terms & Conditions of www.melakaprinting.com.my
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Agent / Membership Registration