kedaiCCTV Installer & Agent Form

  • Agent*
  • Full Name*
  • IC No*
    Example: 123456789012
  • Company Full Name*
  • Company Registration No
  • Company Address*
  • Phone No*
  • Alternate / Mobile No*
  • Fax No
  • Email Address*
  • Bank Account No
    Please state the Bank name such as Maybank / CIMB / etc
  • Interested to install:*
  • State to Install*
    Please select the state you are interested to install
  • District
    Please state the district that can make an installation
  • Security Code*

     

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