VENDOR APPLICATION FORM

STATUS : NEW BSS SUN

SUN CODE :

I. PERSONAL DATA
VENDOR NAME:
NAMA VENDOR

VENDOR CONTACT :
NAMA CONTACT

VENDOR ADDRESS:
ALAMAT VENDOR

PHONE NO:
NO TLP

MOBILE NO:
NO HP

FAX NO:
NO FAX

EMAIL ADDRESS:
ALAMAT EMAIL

II. BANK INFORMATION

BENEFECIARY NAME:
NAMA ACCOUNT

ACCOUNT NO:
NO REKENING

BANK NAME:

BRANCH:
CABANG

BANK ADDRESS:
ALAMAT BANK