Dealer Application

How to become a dealer form

Payment through Maybank

* Kindly inform that we only provide a payment through Maybank account at this moment.

Any inconvenience cause is regretful.

Thank You.

Step 1: Pay Deposit.

Please use
Maybank2u, ATM Transfer, Cash Deposit or to Maybank counter to make a
payment with the amount that been given ( RM 864 ).

Account details:

Account No: 1645 4813 0250

Name: Norhaslinda Jalil
Email: info@biodiabetes.com


Click Here for Maybank2U.com - Internet Banking

Step 2: Fill up the application form below

** must fill in

Name**:

Address**:
Company
Name(if any):

Telephone No
@ H/P**:

Fax No:

Email
Address**:

Product details (choose product that interested in)

Choice
1:

 Choice
4:

Choice
2:

 Choice
5:

Choice
3:

For more
information, please email to 
harun@biodiabetes.com

Transaction details**: