Übertech, Inc.

Tel. Nos. (632) 8705-1173 | 8721-8888 |8 738-2324

Fax No. (632) 8705-1226 loc. 8803

DEALERSHIP APPLICATION FORM

Business Name:
Address:
Type of Business:

DIY Components (Do It Yourself) Consumer Products Corporate Reseller

Chain Store E-tailer Retailer Sub-Distributor System Integrator / Value-added
Reseller

Phone No: Fax No.:

Mobile Phone No: Pager No:
Email Address: Website:
CORPORATION / PARTNERSHIP SOLE PROPRIETORSHIP
SEC. No. DTI Reg. No.
Date Issued: Date Issued:
Authorization Capital: Amount Capital:
Subscribed Capital: Paid-up Capital:
Paid Up Capital: Tax Acct. No.
BOARD OF DIRECTORS
NAME ADDRESS POSITION

COMPANY OFFICERS
President: Birth date:
General Manager: Birth date:
Purchaser: Birth date:
Accountant: Birth date:
SUPPLIERS
COMPANY ADDRESS PHONE TERM CONTACT PERSON
NO. S

BANK REFERRENCE
BANK BRANCH, ADDRESS PHONE CHECKING/ CURRENT
NO. ACCT. NO.

Documents required:
-Copy of SEC Registration Certificate and DTI -Business Permit
-Articles of Incorporation -Registration of TIN / VAT
-Company Profile -Picture of store/shop

Dealership Application Form

Confidential
 Übertech, Inc.
Tel. Nos. (632) 8705-1173 | 8721-8888 |8 738-2324
Fax No. (632) 8705-1226 loc. 8803

SKETCH OF OFFICE VICINITY:

TERMS AND CONDITIONS:

1. Dealers agree to pay in cash for initial transaction with Übertech, Inc.
2. Terms shall only be given to clients after submitting all necessary documents.
3. Dealers shall not disclose any of the Confidential Information which includes product pricing, product
roadmap, dealership incentives to any person other than those of the dealer’s employees, officers and agents
who are required to receive and consider the Confidential Information in the course of (and solely for the
purpose of marketing the products to end users and sub-dealers)

I hereby certify that the information provided in this application is true and correct. I understand that signing
this application gives Übertech, Inc. the right to proceed with reference checks on any names stated in this
application.

Name:______________________ Title:__________________
(Please Print)

Signature:___________________ Date:_____________________

Approved:

SIGNATURE

Date:

Dealership Application Form

Confidential
 Übertech, Inc.
Tel. Nos. (632) 8705-1173 | 8721-8888 |8 738-2324
Fax No. (632) 8705-1226 loc. 8803

Dealership Application Form

Confidential