Dealer Registration Form

General Information
Company Name :*
Responsible Synnex Inside Sales:*
Tel :* Fax :*
Address :

Please fill in maximum 5 names of frequent users.
(1)Name : Title :
Tel : Fax :
E-Mail Address :



(2)Name : Title :
Tel : Fax :
E-Mail Address :



(3)Name : Title :
Tel : Fax :
E-Mail Address :



(4)Name : Title :
Tel : Fax :
E-Mail Address :



(5)Name : Title :
Tel : Fax :
E-Mail Address :

*Please fill in the Person-in-charge section for direct contact in any case.

Person-in-charge
Name : Title :
Tel : Fax :
E-Mail Address :

Remarks:
Please send the copy of Business Registration and Name Card to Synnex Tech. Inl'l(HK) Limited at 2753 0337 or mail to 16/F., Metro Centre I, 32 Lam Hing Street, Kowloon Bay after submitting the form for easy reference.