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Euro-Circuit Technology Sdn Bhd Monitoring Form

We would love to hear your feedback on how we can improve your experience!

1

Agent Information

2

Current Client

3

Proposed Client

4

Terminated Client


1. Agent Information:

1.1 Agent Name
1.2 Agent PIC Info
1.3 Agent Email Address
1.4 Agent Telephone Number
1.5 Total Volume Sold (Liter)
2. Current Client:

2.1 Current Client Info

Fill in the info for all current clients in order as stated in Appointment Letter / Addendum / Agreement

3. Proposed Client:

3.1 Proposed Client Info

Fill in the info for all proposed clients that are currently penetrating (Leave blank if not relevant)

4. Terminated Client

4.1 List of Terminated Clients

Insert the clients that are no longer penetrating and its reason (Leave blank if not relevant)