CREDIT LINE APPLICATION FORM

Customer Information Sheet

BUSINESS INFORMATION
Business / In Business
Company Name Since
Business Address
Email
Contact Number
Address
Legal Form Under Please check the appropriate box or indicate your answer if not within the choices
Which the Business Sole Proprietorship Partnership Corporation
Operates Cooperative Others ____________________________
Business Office Owned Rented Php per month
Name of Parent
Company, If Subsidiary
Contact Person Responsible
Designation
for Business Transactions
Landline Nos. Mobile No.
Accounting Head Mobile No.
BUSINESS OWNER’S INFORMATION (For Sole Proprietorships Only)
Complete Name
Permanent Address
Home Landline No. Mobile No.
If Married, No. of
Civil Status
Name of Spouse Dependents
Birthday Citizenship
Present Address
CORPORATE / PARTNERSHIP / COOPERATIVE OFFICERS’ INFORMATION
Officer’s Name 1 Designation
Home Address 1 Mobile No.
Officer’s Name 2 Designation
Home Address 2 Mobile No.
Officer’s Name 3 Designation
Home Address 3 Mobile No.
Officer’s Name 4 Designation
Home Address 4 Mobile No.
Officer’s Name 5 Designation
Home Address 5 Mobile No.
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Customer Information Sheet – Credit Line Application

PROPERTIES OWNED (Use separate paper if necessary)

Description / Location Market Value If Mortgaged, To Whom

Real Estate
( Land / Buildings )

Heavy Equipment

Share of Stocks
Other Assets
BANK REFERENCES
Bank Name 2
Branch
Account Type Account No(s)
Contact Person
Contact No.
Designation
Bank Name 2
Branch
Account Type Account No(s)
Contact Person
Contact No.
Designation
Bank Name 3
Branch
Account Type Account No(s)
Contact Person
Contact No.
Designation
TRADE REFERENCES
Supplier’s Name 1
Contact Person
Contact No.
Designation
Supplier’s Name 2
Contact Person
Contact No.
Designation
Supplier’s Name 3
Contact Person
Contact No.
Designation

Information Provided by: Designation: Documents Submitted

___ Mayors Permit ___ Financial Stmt. (Audited)
___ DTI Reg Cert ___ Valid ID (For Sole Prop)
Date Signed:
___ BIR Reg Cert ___ Others
Signature Over Printed Name ___ SEC Reg Cert

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Customer Information Sheet – Credit Line Application

AUTHORITY TO CONDUCT BACKGROUND

AND CREDIT CHECK

KNOW ALL MEN BY THESE PRESENTS:

I (We), the undersigned, do hereby authorize Union Galvasteel

Corporation, to whom my (our) credit application is submitted, to obtain,
through its authorized representative/s and accredited third party
investigators, credit reports that include information about such as but not
limited to personal data, business profile, records from bank, trade, court,
assessor’s office and other data as may be deemed necessary in connection
with the establishment of my (our) credit worthiness.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________________________ in _______________________________.

…………………………………………….. / …………………………………
Signature Over Printed Name / Position Tile
_______________________________________________________________

DATA PRIVACY CONSENT

I am (We are) giving my (our) authority and consent to Union Galvasteel

Corporation and its accredited third party partners to have my (our)
information collected, stored, shared and processed in accordance with the
Republic Act 10173 otherwise known as Data Privacy Act of 2012 and other
laws and regulations.

…………………………………………….. / …………………………………
Signature Over Printed Name / Position Tile

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