UKS Affiliates Form
1. Company Name:
*
2. Key contact person:
*
3. Designation:
*
4. Contact number:
*
5. Email ID
*
6. Outlet's name (if any):
7. Outlet address(es) Maximum 3 outlets:
8. Nature of Business:
9. Describe your product & services:
*
10. Website address:
11. Promotion or privileges offered to UmmikuSayang members:
*
I have read and agree to abide the UmmikuSayang Affiliates program
*
Yes
No
Date:
*
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Copyright 2008 Ummikusayang Sdn Bhd
