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Reference Letter Form for a New Customer

When you kindly refer a new customer to us, please fill out this form and send it to us.

Your Information (Information of a person who is currently filling out this form)
Items marked with * are mandatory.

Company name*
Name*
Address*
Address line 1:
Address line 2:
City: 　
State / Province / Region:
Zip code:
Country:
Email address*
NOTE: An email address with a "+" symbol cannot be used.
Phone number*
Registered for a membership on this website?*

Customer Code: Leave it blank if you are unsure.

[Information of the Person You Refer to Us]
As far as you know

Company name*
Name*
Address*
Address line 1:
Address line 2:
City: 　
State / Province / Region:
Zip code:
Country:
Phone number
Type of business*

If other, please specify.

Business content*

Relationship*

Make sure your entries are correct and click Confirm button.


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