AlphaInvestmentBank.com

PROFESSIONAL ADVISOR
Membership Registration Form

The information you submit on this registration form, will be listed on Alphainvestmentbank.com only to the degree of disclosure you request in the "Listing Options" section of this form. For our terms and conditions refer to the Registration Terms and Conditions and Data Protection and Privacy Policy.

Approved Advisor members can access our databank of Start-up Companies, Business Buyers and Sellers; our CROWN - a directory of Investors, Venture Capitalists and Angels; our CASTLE - a directory of Banks and Financial Institutions.

When you have completed and submitted this form, we shall review your information and activate your registration upon approval.

A. Advisor Profile

Do you register as an individual or on behalf of your company?
Individual Corporate Other

User Name :
Password :
Confirm Password:
Password Reminder Question :
Answer :
Company Name:
Company Type:
Co. Registration No.
Address1:
Address2:
Postcode :	City :
State :
Country :
Telephone1 :	Ext.
Telephone2:	Ext.
Fax1
Fax2
Cable
E-mail :
Website :
Position:
Chairman :
Executive Directors :
General Managers :
Senior Managers :

B. Company Information

Date Incorporated	(dd/mm/yy)
Company Secretary/ Lawyer
Location	City	State/Country

Person to Contact
Title / Position
Individual or Corporate principal activity

C. Location:

D. Please tick an Industry category of interest:

Advertising	Agriculture	Biotechnology
Banking & Finance	Commercial Services	Chemical
Distribution	Education	Energy
Entertainment	Manufacturing	Foods
Franchise	Telecommunications	Infrastructure
Publishing	Restaurant	Transportation
Medical/Health	Real Estate	Consumer Service
Waste Management	Information Technology	Earth Science
	Others Please State:

E. Referral Information

Who referred you to AlphaInvestmentBank.com?

What is his/her e-mail address?

What is his/her phone number?

What company/firm do they work for?

What city/state are they in?

If you were not referred by person or firm, how did you hear about us?

F. Listing Options

Carefully select one of the three Listing Options below. For Options 2. and 3., you hereby acknowledge and agree to appoint "The Company" (referred to in our Registration Terms and Conditions & Data Protection and Privacy Policy) to act as your Intermediary and Consultant.

AlphaInvestmentBank.com reserves the right to not list a company.

1. List my company with full identity.
(AlphaInvestmentBank.com may list my company's full information submitted to AlphaInvestmentBank.com).
2. List my company without identity and contact information. (Entrepreneurs, Investors, Business Buyers and Sellers will not be able to access information about my company's identity and contact, except for information on my Corporate Activity and Industry Category of Interest.

3. Do not list my company. (Entrepreneurs, Investors, Business Buyers and Sellers and other members, will not be able to access information about my company).

G. Membership

Please select one of the following membership packages.

Annual - RM3,800
US$1,000

Quarterly - RM1,150
US$300

H. Mode of Payment

	Cheque Bank certified cheque payable to: Digital Hub Sdn. Bhd. and sent to us at: 36th Floor, Menara Citibank, 165 Jalan Ampang, 50450 Kuala Lumpur, Malaysia
	Bank Transfer (Telegraphic Transfer) Payee: Digital Hub Sdn. Bhd. Banker: Citibank Berhad Branch: Menara Citibank, 165 Jalan Ampang, Kuala Lumpur, Malaysia. USD Account No. 0/195294/011
	On-line Credit Card

Please check that you have keyed-in the correct data.

By clicking the Send button you acknowledge having read our Registration Terms and Conditions & Data Protection and Privacy Policy and that you fully understand and accept the same.

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