Date *
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COMPANY & ADDRESS
Company *
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Company Registration Number *
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Company Address *
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City *
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Province *
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Telephone Number *
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Fax Number
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Website (http://)
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BUSINESS DETAILS
Number of Employees *
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Core Business *
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Other services provided *
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What other brand(s) do you sell now? *
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Owner/ Decision Maker/ CEO *
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Name : Designation :
Email : Mobile Number :
Primary Contact Person *
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Name : Designation :
Email : Mobile Number :
Secondary Contact Person
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Email :  Mobile Number :
Marketing Contact Person
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Name : Designation :
Email : Mobile Number :
Finance Contact Person *
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Name : Designation :
Email : Mobile Number :
Form Submitted by *
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NOTE: The below email address will be receiving a copy of the submission info.
Email Address *
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Your existing Top 10 customers that you would like to work with HTech
Note: Please input '0' if the field is not applicable.
Company Name 1 *
:
Company Name 1 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
  :
Company Name 2 *
:
Company Name 2 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
  :
Company Name 3 *
:
Company Name 3 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
  :
Company Name 4 *
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Company Name 4 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
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Company Name 5 *
:
Company Name 5 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
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Company Name 6 *
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Company Name 6 Detail *
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Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
  :
Company Name 7 *
:
Company Name 7 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
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Company Name 8 *
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Company Name 8 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
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Company Name 9 *
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Company Name 9 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
  :
Company Name 10 *
:
Company Name 10 Detail *
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Location (Province) :    
Company Size : Users  
Products Sold :
PO/Revenue/year (USD) :    
Account Manager   Name Mobile Email
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Declarations *
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Should you require further assistance, please email to sales@ht-dist.com and do not hesitate to contact us at +84 28 3911 1247 / +84 28 3911 1248 / WhatsApp/Zalo +84906724636.

Copyright © HTech Vietnam. All Rights Reserved.
Address:   Room RG-05.69, Floor 5, 151 - 155 Ben Van Don Street,
Ward 6, District 4, Ho Chi Minh City, Vietnam

Web:  www.ht-dist.com   Email: sales@ht-dist.com   Tel: +84 28 3911 1247 / +84 28 3911 1248