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Product and Firm Names Application Form


  Principal Info
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Name:    Sex *
Birthday:  *
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Birth place: *
Partners:
  Industry Info
Industry name: *
Industry nature: *
Using name:
Company Name: *
Remark:
  Contact Information
Contact person: *
Address: *
Tel: *
Mobile: *
Email: *
Remittance:
 
Bank: Currency *
Remittance date *
 
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Item:
Name:   
Birth place:
Partners:
Industry name:
Industry nature:
Using name:
Company Name:
Remark:
Contact person: Address:
Tel: Mobile: Email:
Remittance: Currency: Bank:
Discount amount:  RMB 
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