Bespoke Member Registration Form

BESPOKE INTERNATIONAL GROUP

MERCHANT REGISTRATION FORM
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Company Details
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Registration Number*
No symbols required
Company Website*
Brand Name*
Input a brand name that represents your company
Nature of Business / Industry*
Nature of Business / Industry (For Others)
Existing Business Promotion Methods Used*
Existing Business Promotion Methods Used (For Others)
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Top Management Information

CEO / Managing Director
Full Name*

First NameLast Name
Designation*
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
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Company Representative Information
Full Name*

First NameLast Name
Designation*
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
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Declaration

Upon submission of the BESPOKE INTERNATIONAL GROUP Merchant Registration Form, I declare that all the information furnished above is true and correct. I hereby allow BESPOKE INTERNATIONAL GROUP SDN BHD to utilize all the information provided by my company and I at its sole discretion for the LUXURIATE CLUB's use. I acknowledge and understand that there are Terms & Conditions applicable for the said club.
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