Date:

Blk 37 Lot 12, Maria Cristina Village, Latag, Lipa City, Batangas ● 0917 177 3593 / 0906 360 7203 ● spl.agritrading@gmail.com ● Spl Agri

CUSTOMER INFORMATION SHEET

ABOUT YOU
First Name Middle Name Last Name Birthdate Birthplace
/ /

Home Address own rent living w/ relatives Tel. Nos. Education

Landline Mobile Number

Permanent Address Email Address Civil Status Age Occupation

single separated

married widow(er)

Spouse
First Name Middle Name Last Name Birthdate Email Address
/ /

Tel. Nos.
Landline Mobile Number Citizenship

Employers name & Address Years Employed Occupation

ABOUT YOUR BUSINESS

Business Name (and trade name if applicable) Type of Bussiness TIN no.
proprietorship
partnership corporartion
Office Address Tel. Nos. No. of years in business
Landline Mobile Number

Year Established No. of Employees Nature of business Other occupation/Business engaged before?

Major Suppliers Address Contact Person & Number Supplier Since Monthly Purchaes Term of Purchase
CBD COD

php Credit days

CBD COD

php Credit days

CBD COD

php Credit days

Banks Address Contact Person & Number Bank Since Type of Account
checking time deposits

savings other
checking time deposits

savings other
checking time deposits

savings other
checking time deposits

savings other
Assets Liabilities
Real Estate Commercial/Buildings/Lots
Accounts Payable
php (Outstanding balances from suppliers) php

Resedential Houses/Lots/Agricultural Properties etc.

php Bank loans: Housing , Auto Loans php

Accounts Receivable
php Other loans (Credit Cards, etc…) php

Inventory
php Total Liabilities php
Vehicles/Trucks
php Other Source of Income php

Total Assets *please provide copy of TCT's/Tax Declaration/proofs of ownership

php

Cash Before Delivery Cash On Delivery Credit

(CBD) (COD) (Any Payment Term Requiring a Credit Line)

BIR Certificate of Registartion BIR Certificate of Registartion

(Form 2303) to withhold taxes (Form 2303) to withhold taxes

Bank Verifications Bank Verifications

BIR Certificate of Registartion 2 X 2 ID Pictures or Government ID's 2 X 2 ID Pictures or Government ID's

(Form 2303) to withhold taxes
Business Permit / DTI Registration Business Permit / DTI Registration
(Proprietorship) (Proprietorship)

List of Authorized Respresentatives

List of Properties

Personal Guarantee

I certify that all the above stated information is true and correct.

AUTHORIZED SIGNATURE
(Signature over printed name)