AlphainvestmentBank.com

INVESTORS
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 Registration Terms and Conditions & Data Protection and Privacy Policy.

Approved Investor members can access our databank of Start-up Companies, Merger and Acquisition Opportunities; 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. Investor Profile

Category of Registration

User Name :
Password :
Confirm Password :
Password Reminder Question :
Answer :
Company Name:
Designation:
Co. Registration No.
Address1:
Address2:
Postcode :	City :
State :
Country :
Telephone1 :	Ext.
Telephone2:	Ext.
Fax1:
Fax2:
Cable
E-mail :
Website :
Year Founded :
Persons to contact :
Title / Dept. Head	Name

B. Industry Preference

Please tick at least one of these Industry preferences:

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
	Other Industry:

C. Investment Capital

C1. Capital Managed :	US$
C2. Size of investment preferred :	US$ Min. US$ Max.

D. Preferences

D1. Preferred Stake :	%
D2. Geographic Preference
D3. Type of Financing :	Equity Debt
D4. Stage Preference :

E. Investment History
Please state your last 5 investments:

Year	Location	Nature of Investment / Industry	Value (US$)

F. 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?

Would you like to recommend AlphainvestmentBank.com to your business associates?

name	e-mail

G. Listing Options

Carefully select one of the three Listings 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. (Other members will not be able to access information about my company's identity and contact, only information on my investment interest and preferences.)

3. Do not list my company.
(Other members will not be able to access any information about my company.)

H. Membership

Please select a Membership Package.

Annual - US$390

Quarterly - US$100

I. Mode of Payment

	Cheque Bank Certified Cheque or Money Order payable to Digital Hub Sdn. Bhd. at: Unit A105 Kyoto Gardens, Persiaran Bukit Jaya, Bukit Antarabangsa, 68000 Ampang, Selangor, Malaysia
	Bank Transfer (Telegraphic Transfer) Payee: Digital Hub Sdn. Bhd. Banker: RHB Bank Berhad Branch: KLCC Branch, Kuala Lumpur, Malaysia. Multi-Currency Account No. 614138 - 00000438

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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