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MUB LAB & ENGINEERING (M) SDN BHD

No. 30 Bawah, Jalan Jaya 1/5B


Taman Pagoh Jaya,
84600 Pagoh, Johor
Office: 06-9730110 | Email: sales@mublab.com

VENDOR REGISTRATION FORM

COMPANY NAME
COMPANY NAME

TELEPHONE MAILING ADDRESS

EMAIL

POINT OF CONTACT WEBSITE


(NAME & TITLE) CONTACT EMAIL

CONTACT PHONE 1 CONTACT PHONE 2

COMPANY OVERVIEW
GENERAL DETAILS
OF SERVICES/ GOODS

DATE COMPANY
BUSINESS TYPE
ESTABLISHED

MAXIMUM YEARS PREVIOUSLY


AMOUNT REGISTERED

ADDITIONAL INFO

BANKING INFORMATION
BANK NAME

BENEFICIARY NAME BANK ADDRESS

ACCOUNT NUMBER

CERTIFICATION
I hereby affirm that all information supplied is true and accurate to the best of my knowledge and belief, and I understand that this
information will be considered material in the evaluation of quotations, bids, and proposals. Notice must be given of any change in
status impacting the information provided within (14) days of said of change.

PRINTED/ TYPED NAME TITLE

SIGNATURE DATE

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