3F MCY BLDG ROOSEVELT AVENUE BRGY.

SAN ANTONIO QUEZON CITY

Telefax #(02) 3711121 email : cellzone.opsassistant@gmail.com

COMPANY INFORMATION
Company Name : ____________________________________________________________________________________
Trade Name : ____________________________________________________________________________________
Business Address : ____________________________________________________________________________________
Nature of Business : ___________________________No. of Yrs in Business_______________________________
Phone Number : ___________________________Fax Number : _______________________________
COMPANY OFFICERS
Operations Manager : ___________________________Contact No. _______________________________________
General Manager : ___________________________Contact No._______________________________________
Purchasing Manager: ___________________________Contact No. _______________________________________

SINGLE PROPRIETORSHIP
Name : ___________________________Mobile No. ___________________________________
Residence Address: ______________________________________________________________________________
Rented : ( ) Owned: ( )
Nationality : ___________________________Name of Spouse: ____________________________
Employed: Yes : ( ) No: ( ) Other Business: ( )
Company : ___________________________Trade Name: ____________________________________
Name : ___________________________Contact No.
Address: ______________________________________________________________________________
DTI Registration: ___________________________TIN Number: _________________________________
VAT Registration: ____________________________________

PARTNERSHIP / CORPORATION
DIRECTORS / PARTNERS INFORMATION
NAME ADDRESS POSITION

SEC NUMBER VALIDITY

BANK REFERENCES
NO. OF
CONTACT PERSON & YRS IN
BANK BRANCH ACCT NO.
NUMBER THE
BANK

TRADE REFERENCES (Firms from which you have required credit )

Company Address Contact No. Terms Credit Limit Contact Person

DELIVERY DETAILS
Schedule of Delivery
Delivery Address:
Unless revoked in writing, the following persons are authorized to sign order and/or receive goods from
MOLECULE CELLPHONE ACCESSORIES & GEN. MERCHANDISE

Name & Position Contact No. Speciemen Signature

I/ We certify that the foregoing information stated are true and correct, and hereby authorized
MOLECULE CELLPHONE ACCESSORIES & GEN. MERCHANDISE to obtain pertinent credit information
from banks, credit card company , financial institutions and other government financial institutions ,
fromwhom credit is requested.

__________________________________________________________________________________________
Owner / Authorized Representtive Date :

Checklist of Attachments :
I. Single Proprietorship II. Partnership / Corporation
( ) DTI ( ) Articles of Incorporation
( ) TIN / VAT Registration ( ) SEC Registration
( ) Filled out Customer Info Sheet ( ) TIN / VAT Registration
( ) Filled out Customer Info Sheet
Sketch of Business / Office Address:

Sketch of Delivery Addrerss

______________
______________
______________
 SARI-SARI STORE - CLIENT
INFORMATION FORM

3F MCY BLDG ROOSEVELT AVENUE BRGY. SAN ANTONIO QUEZON CITY

Telefax #(02) 3711121 email : ccellzonedistribution@gmail.com

COMPANY INFORMATION
Store Name: ____________________________________________________________________________________
Owner: ____________________________________________________________________________________
Business Address : ____________________________________________________________________________________
Home Address : ____________________________________________________________________________________
Nature of Business : ___________________________No. of Yrs in Business:_______________________________
Contact Number: ___________________________Landline Number: _______________________________
Rented : ( ) Owned: ( )
Nationality : ___________________________Name of Spouse: ____________________________
Employed: Yes : ( ) No: ( ) Other Business: ( )
DTI Registration: ___________________________TIN Number: _________________________________
VAT Registration: ____________________________________

BANK REFERENCES
NO. OF
CONTACT PERSON &
BANK BRANCH ACCT NO. YRS IN
NUMBER
THE BANK

TRADE REFERENCES (Firms from which you have required credit )

Company Address Contact No. Terms Credit Limit Contact Person

DELIVERY DETAILS
Schedule of Delivery ____________________________________
Delivery Address: ____________________________________
Terms: ____________________________________
Unless revoked in writing, the following persons are authorized to sign order and/or receive goods from
MOLECULE CELLPHONE ACCESSORIES & GEN. MERCHANDISE

Name & Position Contact No. Speciemen Signature

I/ We certify that the foregoing information stated are true and correct, and hereby authorized
MOLECULE CELLPHONE ACCESSORIES & GEN. MERCHANDISE to obtain pertinent credit information
from banks, credit card company , financial institutions and other government financial institutions ,
fromwhom credit is requested.

__________________________________________________________________________________________
 Owner / Authorized Representtive Date :

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Sketch of Business / Office Address:

Sketch of Delivery Addrerss

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet

Checklist of Attachments :
I. Single Proprietorship
( ) DTI ( ) Mayors Permit / Barangay Permit
( ) TIN / VAT Registration ( ) Governement ID: __________________
( ) Filled out Client Information Sheet