Association - Corporate Business

Fields marked with an * are required

Membership Information

Company Name^*

Company No^*

Company Address^*

Phone^*

Fax

Email ^*

Contact Person^*

H/P

I/C No^*

Gender^*

Male

Female

Date of Birth^*

Place of Birth

1^st Introducer Name

Introducer Signature

2^nd Introducer Name

Introducer Signature

Supplier Reference

Supplier Company Name & Address	Telephone No	Contact Person	Credit Limit

I hereby certify that all information given in this form is true and correct and agree that if any of the above information found to be incorrect PUKM have the right to dismiss my company from the association. I also certify that I will follow all term and conditions given by PUKM to all member pertaining to the operation and guideline.

Cheque to be made payable to

PERSATUAN USAHAWAN KOMPUTER MALAYSIA

Submit

Please download the printable PUKM Membership Application form

Download PUKM Membership Application Form Here

Completed form shall be email to info@pukm.org.my