REF NO: SYA/CSD/2009/ICUFORM09

SYARIKAT BEKALAN AIR SELANGOR SDN BHD

INDUSTRIAL CONSUMER UNIT (ICU)
CONSUMER DETAILS FORM
Please provide the required information:
1. Name Of Company / Trade Association: __________________________________________
2. Address:___________________________________________________________________
_______________________________________________

Postcode: ________________

3. Account number : ____________________________

4. Occupancy profile (please tick or fill in): Owner ( ), Tenant ( ), Others ( ), ____________________
5. Person-in-charge (of water supply):______________________________________________
6. Tel No (Office): __________________ Fax: ______________ Email: ___________________
7. HP No: ___________________

SMS: _____________

8. Occupation: _______________________________________
9. Purpose / Nature of business

(please tick or fill in):

Schools (

), Hospitals (

), Govts (

),

Commercial ( ), Industrial ( ), Trade Association ( ), ______________________________

10. For trade association, please indicate the number of members: ________________________
11. Is your business process water-dependent? ( please tick ) Yes (

) / No (

12. What is the current capacity of your water storage tank? ( please tick or indicate )
-day supply ( ) 1-day supply ( ) 2-day supply ( ) others (please specify) ________________
13. Current amount of water consumption (monthly): RM ___________ / ___________m.
14. Present / water supply contingency plan ( if any ): ____________________________________
15. What is your companys current major concern with water supply?
____________________________________________________________________________
____________________________________________________________________________
16. Comment / Suggestion
_____________________________________________________________________________
_____________________________________________________________________________

Signature:
____________________
Date:

Company Official Stamp:

Please send your details via email to: puspel@syabas.com.my or post to the address below: General Manager, Customer Service (PUSPEL), Syarikat Bekalan Air Selangor Sdn Bhd, Jalan Pantai
Baharu, 59990 Kuala Lumpur