Balagi - Rattan

BALAGI RATTAN, pt.

Office & Factory :
Jl. Raya Kanci km.9, Kec. Astajanapura,
Cirebon 45181, West Java, Indonesia
Phone +62 (231) 510124, 510687
Facsimile +62 (231) 510686
E-mail: marketing@balagi-rattan.com

Comment

INFORMATION REQUEST FORM

This form applies only to qualified commercial customers
and for full container-load purchases for the purpose of re-sale.
Please take some time to fill out this form.
Also give us some information about your company, as we don't want
to supply our price information to common households.

After review of your completed form, we will contact you by email.

Your Name

Company Name

Position

Address

City

State

Zip Code

Country

Phone Number

Fax Number

Here we need a private email account, not a so called freemail account!

Email Address

Please check carefully that you have given us your correct email account. If submitted incorrectly, we may not be able to contact you.

Your own URL (if applicable)

YOU ARE INTERESTED IN

	To get a password so you can see the complete online catalogue in our web site. As soon as you completed the form, we will give you user name and password by e-mail to open our online catalogue.
	A hard copy of our attractive CD Rom catalogue and pricelist, shipped through Express Courier.
Note: We need to charge a $ 75 = for copying and shipping costs of our attractive CD-Rom catalogue. $ 75 = will be refunded soon at payment of first container order.

Please give us a little description of your company

I don't want to submit now, take me back to the previous page

COMMENT

Please share your information and give us your comments

Your Name
Company Name
Position
Address
City
State
Zip Code
Country
Phone Number
Fax Number
Email Address
Please give us your comment to us

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