BIG C Partner License Order Form

Selected Products

Validation

Hidden

Products

PERSONAL INFORMATION

Full Name(Required)

NRIC No. / Passport No.(Required)

Contact No.(Required)

Email(Required)

Address 1(Required)

Address 2(Required)

State(Required)

City/Town(Required)

Selected City(Required)

Postcode(Required)

Selected Postcode(Required)

Partner | Landlord No.

IMEMBER

Referral Type

iMember

Non-iMember

Name

NRIC No.

C Partner / Biz Director

Registerer Type(Required)

C Partner / Biz Director

Name(Required)

Partner Code(Required)

Referral

Name

Referral Code

REGISTERER DETAILS

Hidden

Verification Type(Required)

Biz Director

Name(Required)

No.(Required)

Selected Payment

DECLARATION

1. I hereby agree to purchase and agreed to pay for the BIG PLAN and Products that I have purchased.
2. I consent that the monthly charges for the above-mentioned product will be charged to the credit card/bank card number indicated on the agreement.
3. I have read, and fully understand and agree to abide by the terms and conditions of the BIG PLAN and Products.
4. I understand that I have the option to personally collect the gifts or request delivery, and I am willing to bear any additional delivery charges.
5. I have read, understood and agree to the terms and conditions of the BIG PLAN and Products.

BANK ACCOUNT INFORMATION

Account Holder Name(Required)

Beneficiary Bank(Required)

Bank Account No.(Required)

Account Type(Required)

Current Account

Saving Account

UPLOAD FILE

Please upload Order Form Softcopy(Required)

Max. file size: 10 MB.

PERSONAL INFORMATION

IMEMBER

C Partner / Biz Director

Referral

REGISTERER DETAILS

DECLARATION

BANK ACCOUNT INFORMATION

UPLOAD FILE

Title