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Reseller Form


Unilike Manufacturing (M) Sdn. Bhd. is warmly welcoming you wish to become our reseller, to promote and popularize Dr. Mist. To cooperate further in future, please fill in the application form to apply as our reseller, we will contact you soon.

* = compulsory to fill in.
     
Company Name : *
Contact Person : *
Address Line 1 : *
Address Line 2 :
City : *
State / Province : *
Postal Code : *
Country :
Telephone : *
Fax :
Email : *
Volume :
1 carton = 12 boxes ( 144 bottles )
   
1 - 10
11 - 50
51 - 100
100 and above
Comments :