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Unit #8, 2nd Floor, Alecel Bldg., Brgy. Telabastagan, City of San Fernando Pampanga, 2000
Contact Number: (Smart) 0968 800 0083 / (Globe) 0916 457 4900
Website: www.azspree.com / Facebook: facebook.com/AZSpree

MERCHANT APPLICATION FORM

Please check as appropriate 1) Individual 2) Partnership 3) Corporation

Business Trade Name: _________________________________________________________________________

Nature of Business: ____________________________________________________________________________
Business Address: _____________________________________________________________________________
Landline No: ___________________________________ Company TIN: _______________________________
Email Address: _________________________________ DTI/Business Permit No: ______________________
Web Page: _____________________________________ Date Issued: _________________________________
MERCHANT REPRESENTATIVE DETAILS
OPERATIONS CONTACT/MERCHANT ADMINISTRATOR (for Settlements, Disputes, Queries etc.)

Name: _________________________________________ Landline No: ________________________________

Position/Title: ___________________________________ Email Address: ______________________________
Mobile Number: _________________________________ Government ID: _____________________________

BANK INFORMATION

Bank Name & Branch: _________________________________________________________________________

Account Name: _______________________________________________________________________________
Bank Account No: _____________________________________________________________________________

Brief Description of products to be sold through AZSpree provided with Price, Weight, Height, Length and Width.

Item Description Price Weight Height Length Width

(kg) (cm) (cm) (cm)

By signing this form, I hereby warrant that: (i) all information stated in this form and supporting documents are true and ac curate; (ii)
this is a free and voluntary act; (iii) all information stated herein and supporting documents submitted herewith are given by me
voluntarily in order to facilitate the processing and evaluation of my application; (iv) I hereby authorize AZSpree and or an y person
authorized by AZSpree to obtain relevant and pertinent personal information about myself and credit information from the credit
information corporation and other financial institutions in the course of evaluating my application, and I authorize the release of such
information by these companies from which my personal data and credit information are requested for the purpose of establishing my
creditworthiness.
Note: Once approved, we will provide you an access to AZSpree dashboard.
Disclaimer:

Please note that the completion of this form will not bind AZSpree in any particular course of action and submitting of the
information shall not create a contractual relationship between the parties unless and until the application has been approved
by AZSpree.

_____________________________________________________________________
PRINTED NAME & SIGNATURE OF AUTHORIZED SIGNATORY / DATE

This portion is to be filled-out by AZSpree

Date Received: Validated By: AZSpree Dash Account: