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To :

7-ELEVEN MALAYSIA SDN BHD (Company No : 120962-P) Level 3A, Podium Block, Plaza Berjaya, No. 12 Jalan Imbi, 55100 Kuala Lumpur. Tel : 03 - 2142 1136 Fax No : 03 - 2142 1249

Application To Be 7-Eleven Panel Of Vendors


Customer's Particulars
1 Company Name Business Registration No Date Of Incorporation : : : Years of business in the market :

Business Address

Telephone No

Registered Office Address

Telephone No

Person To Contact / Designation E-mail Address E mail

: : Mobile No :

Nature of Business Product Category Credit Term

: : :

Type Certification Obatined

: Public / Private Ltd / Partnership / Sole Proprietor / Others : :

Directors / Partners / Shareholders Name Residential Address Position Date of Birth I.C. No. Nationality

Application to be 7-11 Panel of Vendors (3)30708.xls10.04.2008

Application To Be 7-Eleven Panel Of Vendors


8 Paid Up Share Capitals : RM Annual Income / Turnover :

(Plse attach the latest 3 years Profit and Loss Statement and Balance Sheet, ROC Form 9, 13, 24 & 49 or Trading License) 9 a) b) Bank Reference : Customer's banker / Account No / Branch / Type of A/c or facility :

10

Supplies To Top Three Retailers

: Name Sales Amount (RM)

10.1 10.2 10.3

Signed by or for and on behalf of the company Name : I.C No : Designation :

Company Chop

Application to be 7-11 Panel of Vendors (3)30708.xls10.04.2008

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