Account Registration Form

Account Registration Form
Account Information The information given in this section is considered as the information of product that you consider to sell in Speedwork Autocare Malaysia
Account Type : *
Signage (e.g Castrol, Tyreplus, Conti, etc)
Product Category, Tyre

Continental GITI Goodyear GT Radial Michelin
Product Category, Lubricant

Castrol
Product Category, others

Outdoor service
Personal Information The information given in this section is considered as the information of point of Speedwork communication
Name *

First Name Last Name
Mobile number
Email address
Shop Information The information given in this section is considered as the information of point of sales
Shop Name
Shop phone number
Shop Address *

Street Address

Street Address Line 2

City State

Zip Code
Banking Account Information The information provided in this section will be use to receive monetary transfer via online payment made in Speedwork Malaysia
Banking Account Information
Account number
Bank
Bank header copy

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By signing this form, I acknowledge that the information I've given in this form is accurate and I agree all the terms and conditions.
Date

Month Day Year
Date
Signature

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