Long Eggplant

Company Information:

Company Name *

Company Registration No / SSM No *

Date of Incorporation (dd/mm/yyyy) *

SST Reg. No *

Tax Identification Number (TIN) *

Registered Address *

City *

State *

PostCode *

Correspondence Address *

City *

State *

PostCode *

Delivery Address *

City *

State *

PostCode *

Type of Company * Sole Proprietor / Enterprise Partnership Private Limited / Sdn. Bhd. Public Listed / Berhad Others (Please Specify)

If Type of compnay is Others (Please Specify) 

Authorised Capital: 

Paid-up Capital: 

Nature of Business * Hotel Restaurant Restobar Pub /Bar Cafe Home Base Others (Please specify)

If Nature of Business is Others (Please Specify) 

Outlet / Branches Information:

Outlet - 1:

Outlet Name

Outlet Address

PIC Name

Designation

Contact

Outlet - 2:

Outlet Name

Outlet Address

PIC Name

Designation

Outlet Contact

Contact Person Information:

ACCOUNT DEPARTMENT:

Name *

Designation *

Contact Number *

Email *

E-INVOICING:

Name *

Designation *

Contact Number *

Email *

Login Email Address *

Password *

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