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Medical Centres & Clinics
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*mandatory fields

Company info

*Company name

*Company office no

*Premises category

*Nature of business

Contact Person Details

Company Salutation*

*Company contact person

*Company contact person designation

*Contact person mobile no

*Email address

*Do you member any of association?

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For assistance, kindly contact 03-6207 2888 or email info@ppm.my. Thank you.

Medical centres & Clinics Details

Premises name*

Address I*

Address II

Address III

Postcode*

City*

State*

*COUNTRY

*PPM CONTACT

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Tariff Details Medical Centers & Clinics (PP11)

*Licence period

*For tariff Medical Centers & Clinics, this licence period will be music commercement date

*Type of music usage

No. of lobby/reception area/ waiting area

Each patient room (including TV monitor)

Surchage

No. of monitor

No. of video wall/multiple screen

No. of stand-alone karaoke

Premises Details
#	Premises Name	Location/area	State	Date	Type of Music Usage	Premises category	Action
No data available

No	Type of documents	Filenames	Actions
No document uploaded

I/We acknowledge that I have read and understand the Terms And Conditions of Licence Agreement, Additional Terms And Conditions, Terms and Conditions of Use and Privacy Policy as stated herein.

I/We agreed that submission must be supported by a copy of invoice(s) or supporting documents for the purpose of verification of the Declaration by me/us.

I/We declare that the information in this quotation is correct.

Type electronic Signature