Selatan - Referral Form

Fields with an * are required fields. You will be notified about the eligibility of the referral shortly after receipt of your suggestions. Don't include dashes for phone numbers and NRIC. Existing referers only need to fill in the NRIC, Frist & Last Name fields.

Your Information

User Status
*First Name:		*Last Name:
*NRIC Number:		Mobile Phone:
*Position:		*E-Mail:
*Company Name:
*Company Address 1:
Company Address 2:
Company Address 3:
Postcode:		*State:
*Company Phone:		Company Fax:

Referral Information

*BNR Program:
*First Name:		*Last Name:
*Position:
*Company Name:
*Company Address 1:
Company Address 2:
Company Address 3:
Postcode:		*State:
*Company Phone:		Company Fax:

Terms and Conditions:

Gifts and coupons cannot be exchanged for money. Credit is valid for 1 year after the issued date.
Free Gifts and Voucher will only be given under the following condition:

if the referred customer HAS NOT been contacted by Selatan prior to the referral.
Selatan make a sales with the referred customers and the sales order amount is above RM10,000

No self-referral will be accepted. i.e. No referral from the employee to his/her employing organization.