Application Form for CrimsonLogic Services

(Attn: Customer Admin)
* Mandatory field
Company Name * :
Registered Address* :
Postal Code* :
Contact No.* : Fax No.* :
Business Regn No.* :
Industry* :
Estimated No. of Employees :
Company Web Address (URL) :
Product/Service(s) to Subscribe* :

Contact Person

(This individual will serve as the point of contact for CrimsonLogic)

Salutation :
First Name* :
Last Name* :
Designation* :
Contact No.* :
Fax No.* :
Email Address* :

Decision Maker

(This individual is the authorised personnel who will agree to the terms and conditions set forth)
Salutation :
First Name* :
Last Name* :
Designation* :
Contact No.* :
Fax No.* :
Email Address* :

Billing Administrator

A Billing Administrator will be given the access to CrimsonLogic Network Billing System. The Billing Administrator, normally of supervisory level or finance personnel, will be able to view usage and payment incurred by all General User IDs under this account. He/She will also able to print tax invoices.
First Name* : Contact No.* :
Email Address* : Designation* :
Number of User IDs Required* :
Please complete the User Information below:
User 1 User 2
First Name* :
Last Name* :
Designation* :
Contact No.* :
Fax No.* :
Email Address* :
First Name :
Last Name :
Designation :
Contact No. :
Fax No. :
Email Address :
Singapore subscribers can pay by Interbank GIRO (IBG), Credit Card (Not applicable to TradeNet, HDB ResaleNet & EFS subscribers) or Advance Payment.
Overseas subscribers can pay by Credit Card or Advance Payment (TT). Please select (where applicable) and complete the necessary information.
Inter-Bank GIRO
Please complete the attached Application form for Inter-Bank GIRO

Existing CrimsonLogic Subscriber
  If you would like us to deduct from your existing bank account, please provide your existing Account ID that has already been
  GIRO activated :
  Credit Card ( VISA / Master / AMEX)
  Please provide the following card details:-
Bank Name : Card Number :
Expiry Date : (dd/mm/yyyy) Card Holder Name :
Advance Payment
  All Bank Charges and Agent Clearing Charges incurred during the course of clearing the cheque / TT
are to be borne by the customer.
Name of Sales Person :
I/We understand that the Application Form for CrimsonLogic Services is subjected to acceptance by CrimsonLogic.
I/We have read and agree to be bound by the Terms and Conditions set out in the CrimsonLogic General Terms and Conditions.
I/We agree that CrimsonLogic may at its sole discretion amend the Terms and Conditions as and when necessary and such amendments shall be effective upon my/our receipt of the notification thereof.
I /We certify that the above information given are correct and true and I agree to pay for all charges/fees for usage of this application.
Signed for and on behalf of the Subscriber
Company Stamp
Name & Title of Signatory*
Date* (dd/mm/yyyy)
Action By & Date : _______________________________________________ Account ID : ____________________________________________________
Signature : _______________________________________________ User ID : ____________________________________________________
INFCA/ACCTMGMT/FR01 Release 2.0 – January, 2010

CrimsonLogic Pte Ltd

31 Science Park Road, The Crimson, Singapore 117611, Main: (65) 6887 7888, Fax: (65) 6778 5277, (Regn No: 198800784N)