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Distributor Registration

	Application to become Yovell Distribution Outlet
	Please fill in below details:
	Application Date	04/09/2010
	Company Name
	Nature of Business
	Business Reg No
	Business Address

	Name of contact person *
	Identity No *
	Address *
	URL
	Tel *
	Mobile No *
	Fax
	Email 1 *
	Email 2
	MSN
	Skype
	Remarks