Membership – Wien Group

Please Signup

* Username

* Full Name (as per IC)

(Pls do fill up the full name if you're seller who own the business/Director of the company)

* Last Name

* Personal Email Address

* Password

Strength: Very Weak

* Mobile Contact No

Gender

Male

Female

* Full Residential Address in Malaysia /Outside of Malaysia

Address, postcode, city, state, country

* Race

Select Option

(Other-this information is required for respecting diversity)

* Full Company Name as per SSM (State NIL if no registered company)

(if not registered company yet, pls answer question 13 onwards)

* SSM No (State NIL if no company SSM No)

(if not registered yet, pls answer NA and proceed to question 13 onwards)

* Business /Brand Name

* Business Email (If no business Email, please state valid personal email for contact purposes)

* Main Business

A. Food - eg. Cake, Cookies, Brownies, Nut butters, Pickles, Curry Powders, Oils

B. Beauty - e.g. Face Creams, Lipstick, Body Creme

C. Adornments - e.g. Jewelry, Crystal, Headbands, Bags, Purses, Shoes

D. Lifestyle & Services - e.g Massage, Cushion Covers, Bedsheets, Furniture, Education, Tuition, Insurance Services

E. Not Applicable (Just for buyer only)

* Facebook Profile URL (Please state NIL if no facebook account)

* Instagram Profile URL (Please state NIL if no instagram account)

* KKM Cert No. (Please state NIL if no KKM Cert. No) (For Food Seller Only)

* Date of Expiry for Typhoid Jab (Please state NIL if no typhoid jab)(For Food Seller Only)

(3 years from the date last taken and must be a future date is properly calculated) e.g. 12 Dec 2021:

* Appointed Company Representative/Team Member to Post on Social Media on behalf of the company?

Yes (Pls do fill up the following field with the required information - Name, IC No and Contact No)

Name

IC No

Contact No

(Pls do fill up the correct information of the person. If not, the application will not be proceed)

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