Dong-A Pharma Phils.

, Inc
Unit 2803 Atlanta Ctr., Annapolis St., Greenhills, San Juan City, MM, Philippines
Tel.: 727-4512 Telefax: 721-6695 Email: bacchusphil@gmail.com

CUSTOMER INFORMATION SHEET

Date: __________________________
GENERAL INFORMATION
Company Name
Address
Tel / Fax No./s
TIN No.
Main Office
Warehouse / Delivery Address
Email Address

PRIMARY CONTACTS (PURCHASING)

NAME DESIGNATION CONTACT NO. EMAIL ADDRESS

PRIMARY CONTACTS (RECEIVING)

NAME DESIGNATION CONTACT NO. EMAIL ADDRESS
1
2

PRIMARY CONTACTS (ACCOUNTING/TREASURY)

NAME DESIGNATION CONTACT NO. EMAIL ADDRESS

CHECK PAYMENT DETAILS

Account Name
Account No./s
Bank Name / Branch

Authorized Signatory/ies Specimen Signature

FOR REVIEW OF CREDIT TERMS

CREDIT REFERENCES
Contact Person/Contact No.
Major Suppliers (min. of 3) Items Purchased Terms
Agent/Accounting
1
2
3

BANK REFERENCES
Bank Name/Branch Account No./s Contact Person Contact No.
1
2
3

Delivery Lead Time:_________________________________________ Countering Schedule:_________________________

Delivery Schedule:__________________________________________ Collection Schedule:__________________________

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CUSTOMER ACCREDITATION FORM

TO BE FILLED UP BY DONG-A PHARMA

SALES AGENT: __________________________ ACCOUNTING:
Average Monthly Sales __________________________ Reviewed By __________________________
Applied Credit Limit __________________________ Date __________________________
Applied Credit Terms __________________________
Credit History __________________________ Approved By __________________________
Length of Credit History __________________________ Date __________________________
Applied Discounting/Price Level __________________________
Credit References __________________________

ACCOUNTING: NOTE: PLEASE ATTACHED PHOTOCOPY OF THE FF. DOCUMENTS:

Approved Credit Limit __________________________ ( ) SEC / DTI Certificate
Approved Credit Terms __________________________ ( ) Articles of Incorporation
Remarks __________________________ ( ) Business Permit
______________________________________________________________ ( ) BIR Certificate
______________________________________________________________ ( ) Sketch of Office & Warehouse Address