Broccoli

Company Information:

Company Name *

Company Registration No / SSM No *

Date of Incorporation (dd/mm/yyyy) *

SST Reg. No *

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Correspondence Address *

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Delivery Address *

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

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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:

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PIC Name

Designation

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Outlet - 2:

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Contact Person Information:

ACCOUNT DEPARTMENT:

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E-INVOICING:

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