Code: FCM-08

SUPPLIER REGISTRATION FORM Version: 01

Date: 16/11/2018

DATE
COMPANY CODE REGISTERED BY: ID CODE:
DD/MM/YY

Espumas Medellin S.A -

12/01/2021 RUC 1435447-1-634784DV14
4000

GENERAL INFORMATION

Company Name/Name Address Phone/Fax

QUELARIS INTERNACIONAL S.A Edificio Vallarino, Piso 6 +(507)833-8327 / CR: (+506) 2537-3720
Calle Elvira Méndez y Calle
52, Panamá City. República
de Panamá

Zip Code Mobile State City Country

Panamá República de Panamá

CONTACT PERSON

Name Contact E- Mail Phone Fax Mobile

Silvia Brenes Alvarez sbrenes@quelaris.com CR: (+506) 2537-3720. Ext CR: (+506) 2537-5720. CR: (+506) 8429-5633
4018.

Gisella Córdoba Brenes gcordoba@quelaris.com CR: (+506) 2537-3720. Ext CR: (+506) 2537-5720. CR: (+506)
4018.

BANKING INFORMATION

Beneficiary Name Bank name Address Phone ABBA NUMBER SWIFT CODE IBAN

Quelaris Internacional Davivienda (Panamá) Edificio WMB Trading, CAFEPAPA

Calle 50, Panamá

Account Number Currency Code

10002000728 USD

Documents

Copy Tax ID or ID, Certificate from the bank where the payment will be done including the bank
account number, swift number.
Procurement Manager EM