Login Information:
User Name: *
Password: *
Confirm Password: *
Company Information: Date: 20/10/2017
Company Name: * Physical Address: *
Type of Industry:
Type of Business:
Company Registration Number:
Company VAT Number: Zip Code: *
Contact Person: * Postal Address:
Telephone Number: *
Cell Phone Number:
FAX Number:
Email Address 1: *
Email Address 2: Zip Code:
Company Trading References:
Company Name Telephone Number
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2.
3.
Terms and Conditions: Handy Technology Dealer Application Form