DEALER APPLICATION FORM

Company Information
Company legal name :________________________________________
TIN # :_________
Tel # :___________________fax___________________
Email address :____________________Website______________
Billing Address :_______________________City_______________
Shipping Address :________________________City______________
Type of Business
o Corporate
o Partnership
o Sole Proprietorship
o Others ____________
Date Business Commence:________________No. of Employee:_______
Year At Present Location:_____Rented sqm.:_______Own sqm:_______
If rented, Name of lessor:______________________________________
Major Product:________________Pecentage of Sales Revenue:_______

Owner/Officer information
Name:_______________________Title: _____________Residentia Phone( )_________
Home Address:_________________________________________TIN No.___________
Name :_______________________Title: _____________ResidentiaPhone( )_________
Home Address:_________________________________________TIN No.___________
Name :_______________________Title: _____________Residential Phone( )_________
Home Address:_________________________________________TIN No.___________

Specimen Signature of Authorized Signatories

Name:___________________________ Position_______________________
Specimen Signature: ______________,__________________,____________

Name:___________________________ Position_______________________
Specimen Signature: ______________,__________________,____________

Name:___________________________ Position_______________________
Specimen Signature: ______________,__________________,____________

List of office and outlet:

1. ____________________ Name of Authorized Representative _________________
Complete Address: _______________________________ Tel. No.: ____________
2. ____________________ Name of Authorized Representative _________________
Complete Address: _______________________________ Tel. No.: ____________
3. ____________________ Name of Authorized Representative _________________
Complete Address: _______________________________ Tel. No.: ____________
List of Major Products:_____________________________________________________

Upon receipt and acceptance by Queens Link Technology., this Dealer Application will serve as a
binding contract between Applicant and Queens Link Technology. By the submission of this
application, the Applicant agrees to the following terms and condition. Applicant agrees to
abide by the terms and conditions of sale, listed in the price list. Applicant’s signature attests
financial responsibility, ability, and willingness to pay all invoices. The above information is for
the purpose of obtaining credit and is warranted to be true and correct. I/we hereby authorize
Queens Link Technology to investigate the references listed to my/our credit and financial
responsibility.

Signed(Owner):__________________________ Date:___________________

Signed ( Authorized Buyer)__________________ Date:___________________

Requirements
o SEC Registration / DTI Registration
o Comparative Audited Financial Statement / ITR
o BIR Registration
o Business Permit (Current)
o Company Profile
o Sketch of Registered business location

Additional Requirements upon approval

o Contract of Lease if office is being rented
o 2x2 Picture of the Owner/Officer
o Government issued ID of the Owner/Officer of the registered company

_______________________
Signature over Printed Name of
Account Manager