DEALER&KEY FORM (EN)DEALER APPLICATION FORM(DEALER FORM)Registration Date21/11/2024Name - Surname Managing DirectorDate of birthName of Juristic PersonProvinceProvinceBangkokSamut PrakanNonthaburiPathum ThaniPhra Nakhon Si AyutthayaAyutthayaLopburiAng ThongAngthongLop BuriSingburiChainatChai NatSaraburiChonburiRayongChanthaburiTratChachoengsaoPrachin BuriPrachinburiNakhon NayokSa KaeoNakhon RatchasimaBuriramSurinSisaketUbon RatchathaniYasothonChaiyaphumAmnat CharoenBueng KanBung KanNong Bua LamphuKhon KaenUdon ThaniLoeiNong KhaiMahasarakhamMaha SarakhamRoi EtKalasinSakon NakhonNakhon PhanomMukdahanChiang MaiLamphunLampangUttaraditPhraePraeSpreadNanPhayaoChiang RaiMae Hong SonNakhon SawanUthai ThaniKamphaeng PhetTakSukhothaiPhitsanulokPhichitPhetchabunRatchaburiKanchanaburiSamut SakhonSuphan BuriNakhon PathomSamut SongkhramPhetchaburiPrachuap Khiri KhanNakhon Si ThammaratKrabiPhang NgaPhuketSurat ThaniSuratthaniRanongChumphonSongkhlaSatunTrangPhatthalungPattaniYalaNarathiwatDistrictDistrictSub-DistrictSub-DistrictPostal CodePostal CodeAddress No.MooSoiRoadTelephoneMobileEmailContact NamePositionAddress for delivery or contact (in case it does not match with certified copy of VAT)ProvinceProvinceBangkokSamut PrakanNonthaburiPathum ThaniPhra Nakhon Si AyutthayaAyutthayaLopburiAng ThongAngthongLop BuriSingburiChainatChai NatSaraburiChonburiRayongChanthaburiTratChachoengsaoPrachin BuriPrachinburiNakhon NayokSa KaeoNakhon RatchasimaBuriramSurinSisaketUbon RatchathaniYasothonChaiyaphumAmnat CharoenBueng KanBung KanNong Bua LamphuKhon KaenUdon ThaniLoeiNong KhaiMahasarakhamMaha SarakhamRoi EtKalasinSakon NakhonNakhon PhanomMukdahanChiang MaiLamphunLampangUttaraditPhraePraeSpreadNanPhayaoChiang RaiMae Hong SonNakhon SawanUthai ThaniKamphaeng PhetTakSukhothaiPhitsanulokPhichitPhetchabunRatchaburiKanchanaburiSamut SakhonSuphan BuriNakhon PathomSamut SongkhramPhetchaburiPrachuap Khiri KhanNakhon Si ThammaratKrabiPhang NgaPhuketSurat ThaniSuratthaniRanongChumphonSongkhlaSatunTrangPhatthalungPattaniYalaNarathiwatDistrictDistrictSub-DistrictSub-DistrictPostal CodePostal CodeAddress No.MooSoiRoadTelephone (Delivery location)Registration No. (Per Registration Certification)Date of RegistrationRegistration CapitalNumber of employees Average monthly sales for the past 12 months (baht/month)Business days and hoursBusiness typeWholesaleRetailAuction for government workOtherประเภทธุรกิจอื่นๆPerson with authority to orderPositionSignatureUploadList of Affiliated companySubmit the completed form. Ready to send copies of documents and certified copies - affixed with the company seal as follows.Certified Copy of the Certificate of Registration Issued by ministry not more 2 monthUploadCertified Copy of ID Card of Company’s Authorized PersonUploadCertified Copy of VAT Registration Certificate (20 or 01)UploadLacation map of CompanyUploadHouse registration of the person authorized to sign the companyUploadList of shareholders (BOJ.5)UploadConditions for being a distributorThe benefits of being a distributor of Siamtech and Develop Co., Ltd. are rights granted to distributors only.The rights of the distributor to receive information on prices, services, trade information, product and technical information,product logos, etc. are for the benefit of Siamtech and Develop Co., Ltd. The distributor will not publish. Information in a mannerthat causes infringement on Siam Tech and Development Company Limited and/or other distributors.Siamtech and Develop Co., Ltd. reserves the right to change conditions. without prior noticeSubmit Form
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