VENDOR REGISTRATION FORM

Company Name : Contact Person :

(Nama Perusahaan) (PIC yang dapat dihubungi)

Company Address : Phone :

(Alamat Perusahaan) (Telepon)

Mobile :
(Ponsel)
NPWP :
PKP Non PKP Email :
(Surat elektronik)

Insurance Policy : Yes No

(Polis Asuransi) Website :
(Situs Web)
Maximum Liability :
(Nilai Pertanggungan maksimal) Services Type :
(Jenis Layanan)
Term of Payment : days
(Tempo Pembayaran)

Currency : IDR USD Other :

(Mata Uang)

Bank Details
- Bank Name (Nama Bank) :
- Bank Address (Alamat Bank) :
- Bank Account Name (Nama Akun Bank) :
- Bank Account No. (Nomor Rekening Bank) :
- Bank Cliring Code (Kode Kliring) :
- Bank Swift Code (Kode Swift Bank) :

For and on behalf of (company name)

Company Stamp
Signature :
Name :
Title :
Date :