Customer Information

NFM REQUIREMENTS:
1 Company profile
2 Photocopy of ID's
3 SEC / DTI Registration
4 Business Permit 9 At least one piece ID picture of the
5 BIR Registration signatory / signatories
6 Latest credit card statement 10 Articles of Incorporation/Partnership
7 Proof of billing of any ulitities under 11 Picture of establishment/s
the name of entity or the owner 12 Authorization Letter to facilitate credit
8 Latest audited financial statement investigation with your banks & suppliers.

Company Name:
Company Address:

Applicant's Name:
Designation:
Telephone Numbers: Fax:
E-mail Address: Celphone:
SEC Registration No. Tax Identification No:
Nature of Business: Business Establishment Date:
Business Classification: Corporation Sole Proprietorship Partnership

Personal Information
Name of the Owner:
Given Name Middle Name Surname
Mother's Maiden Name:
Date of Birth: Place of Birth:
Civil Status: Nationality:
Home Address:
Years of Stay: Home Ownership: Owned Living with parents
Telephone Numbers: Rented Living with relatives
Mobile Numbers: Mortgaged
E-mail Address

Collection Information (Please indicate AS ABOVE if it is the same as Customer Information)

Collection Address:
Contact Name:
Designation:
Telephone Numbers: Fax:
E-mail Address: Celphone:
Collection Schedule:

Delivery Information (Please indicate AS ABOVE if it is the same as Customer Information)

Delivery Address:
Delivery Schedule:
Contact Name:
Designation:
Telephone Numbers: Fax:
E-mail Address: Celphone:

Credit Information (fill up at least one)

BANK 1 BANK 2 PREPARED BY:
Name:
Branch:
Account Name: Signature Over Printed Name / Position / Date
Account # :
Contact Name:
Designation:
Telephone Numbers:
SUPPLIER 1 SUPPLIER 2 APPROVED BY:
Name: I hereby certify that the information in this
Merchandise Supplied: document are all true and correct.
Contact Name:
Designation:
Telephone Numbers: Signature Over Printed Name / Position / Date
Credit Term:

FOR NFM USE ONLY

Est. Monthly Billings: Terms:
Agent Code: 1st Del:
Application: [ ] Accepted [ ] Rejected Remarks:
________________________________