CrediBill x Pharmaniaga - Buyer Service Agreement

Signing Date

DayMonthYear
Date
Pharmaniaga x CrediBill BNPL Application
Apply for a pre-approved RM50,000 credit limit with a 90-day term, available exclusively for your Pharmaniaga purchases.

Important: This form must be completed by the Business Owner or a Company Director.

Please note that final approval is subject to CrediBill’s standard review process at its sole discretion.
Company Details
Company Registered Name
e.g., ABC Sdn Bhd
Trading Name
e.g., HWC Coffee
Old Business Registration No. (BRN)
e.g., 0383123D
New Business Registration No. (BRN)
e.g., 199701010123
Contact Person's Full Name
Contact Person's Email Address
example@example.com
Contact Person's Mobile No.
Tax Identification No.
e.g., IG10234567890 / C20987654321
Sales and Service Tax No.
Pharmaniaga Account No.
e.g.,2345 / 45478
Business Address

Address

Street Address Line 2

CityState

PostcodeCountry
Business Owner or Company Director: Declaration & Signature
Declaration and Acknowledgements
For and on behalf of the Company/Business
Signer's Full Name
Signer's NRIC No.
Signer's Designation
Signer's Mobile No.
Signer's Email Address
example@example.com
Date

DayMonthYear
Date
Signer's Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Should be Empty:

Pharmaniaga x CrediBill BNPL Application