| *Corporate name: | 
									 | 
							|||
|---|---|---|---|---|
| *Contacts: | 
									 | 
								*Contact number: | 
									 | 
								
							|
| *Sample model: | 
									 | 
								*Sample brand: | 
									 | 
							|
| *Demand quantity: | 
									 | 
							|||
| *Detailed address: | 
									 | 
							|||
| *Notes: | 
									 | 
							|||
