CMTS - Malaysia expert for Furnace, Incinerator, Waste Energy Power Plant, Waste Management and Hospital Waste Treatment

DISTRIBUTOR / REPRESENTATIVE INFORMATION

*Company Name :

*Address:
*Telephone :		Fax:
*E-mail :		Web:
Name of President / General Manager:		Name of designated contact:
The year your firm was formed:

Check which categories best describe your business:

Environmental Engineering
Environmental testing / monitoring
Environmental product trading
Consulting
Trading
Manufacturer, if so, write type of products:

Check ownership of your firm:

Private Firm
Central government owned
Provincial government owned
Municipal government owned
Office of/ Division of/ association with a foreign firm, if so,write to foreign firm's Name :

Check in which area(s) your business is involved:

Solid Waste Management
Air Pollution Control
Water and waste water treatment
Noise control
Monitoring / testing
Others

Check your firm's average number of employees:

Under 10

10 - 50

51 - 100

101 - 150

151 - 200

201 - 300

301 - 400

401 - 500

Over 500

Check your firm's current annual gross sale (US$):

under $100,000

$100,000 - $500,000

$500,000 - $1 million

$1 million - $5 million

$5 million - $10 million

over $10 million

List your firm's three reference customers:

1.	Customer name & telephone:
	Type of Business :
2.	Customer name & telephone:
	Type of Business :
3.	Customer name & telephone:
	Type of Business :

I have carefully reviewed and answered the foregoing and confirm the accuracy of the same. I understand that if there are any errors or omissions in the above, it may result in CMTS SDN. BHD. declaring and further contracts or business agreement being null and void.

*Name :

Date:

*Verification Code:

*Required Field

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