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APPLICATION FORM

 

* Please complete the form in full.

* Fields marked * must be filled.

 

Company Name :
Name : *
Email Address : *
Home Contact : *
Office Contact : *
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Gender : Male  Female
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* My AV Systems is faulty. Please checkmark () the appropriate faulty equipment.
COLOUR TV  MINI HI-FI  SUB-WOOFER 
AMPLIFIER  DVD RECORDER  SPEAKER 
VCD / DVD PLAYER  VIDEO PLAYER  LASER DISC PLAYER 
MICROPHONE / WIRELESS  PROJECTOR  CASSETTE DECK 
CD PLAYER  CD RECORDER  GPS     
OTHERS