ACCOUNT OPENING FORM

Date : DD / MM / YYYY
Company Name :
Department : PIC :
Company
Address :

Telephone No. : FAX No. :

Head Office
Address :

Telephone No. : FAX No. :

President (the person who makes financial decision) Type of Industry/Main Business

Capital Stock Expecting (recent) Turnover Year Earlier

USD : Yearly Turnover USD : USD :
IDR : million IDR : million IDR : million

Established : Fisical Year End : Number of Employees :

Associated Company (if any ) The relationship or busines with the company Investment ratio
%
Branch Office/Business Office Main Bank
Bank Name : Branch :
Main Client Major Product to the Client

Invoice/Billing Person ҉ in case of other payment, please fill in here

Invoice/Billing ҉ in case of other payment, please fill in here

Address :

Telephone No. : FAX No. :

[Any Conditions]

Cut Off Date for Invoice : Payment Date : Credit Terms : 30 days

Means of Payment : Telegram Transfer ( T/T ) Letter of Credit ( L/C ) Other ________________________

Type of invoice : PDF (by e-mail) Original (by air mail)

Date you hope to receive the Bill Date you hope to receive the Delivery Note

[Other Important Remarks for Payment / Transaction]

The remitter will pay the bank transfer service fee

PT. FOKUS VISITAMA GLOBAL INDONESIA