PT ROYAL CANIN INDONESIA

FOR INTERNAL USE - Please use drop downs in the entire form (All drop downs highlighted in green)

New Account No Company Set up Sole Proprietor Mode of Sale Offline BDM TYA

Navision Account No. 101062

Account Amend No Channel VET Pets handled Both
CSO
Is it an existing customer
No Customer Classification D Customer Segmentation Independent Conflict of Interest Is the customer related to anyone associate in RC?
(Duplicate check done?)
No of Active Practicion No of Branch/Clinic
*only for VET

Customer Business Information

Company Stamp
Company Registered Name
(Accd to Registration)

Shop / Clinic Name

(If differs from above)

Address GPS Code

N E
Billing Address
(Legal Address)

Postcode City State & Country Shop / Clinic Stamp

Address

Delivery Address
(If differes from billing
address)
Postcode City State & Country GPS Code

N E

Owner Name (Accd to

Tel No. Email
registration)
Person In Charge (If differ Mobile Number 62 818568062 Email
from owner, letter of Mobile Number Email
appointment required) Mobile Number Email
Are you related to any person in RC? Is yes, please state name of the Associate:
Payment Terms
Credit Days CASH Credit limit
Payment Mode Bank Transfer Potential Business per month
Credit Limit Agreed Growth %
Supporting Documents Required (Attach)
Registration Documents
NPWP ID/E-KTP ID No YES
Bank document for account number
Picture of the PET SHOP/Clinic YES
Certification of Clinic (only for VET) YES
Other Information (Only for PRO)
How many exhibition/show do you participate in 1 year? Ras Code RAS Total Adult Total Kitten/Puppy
Refer A-PRO : Do you get referrals from your colleagues to sign up for
Royal Canin? (If yes, please fill in below information)
Breeder/Cattery Name

Approvals & Sign Off

Please fill in Name details Signature Place Date Name of the Customer

Name of the Creator (Sales):

Name of the Approver (Channel Pillar Head or Sales Manager):

Signature & Stamp of the Customer

Name of the Approver (S&F):
Date:
Place
 INFORMASI CABANG

CABANG 1
Tipe Business : Pet Shop DIY Stores
Nama Outlet :
Alamat :

Provinsi :
Kota : Kode Pos :
Kontak Utama :
Nomor Telepon : No Fax :
Email :

CABANG 2
Tipe Business : Pet Shop DIY Stores
Nama Outlet :
Alamat :

Provinsi :
Kota : Kode Pos :
Kontak Utama :
Nomor Telepon : No Fax :
Email :

CABANG 3
Tipe Business : Pet Shop DIY Stores
Nama Outlet :
Alamat :

Provinsi :
Kota : Kode Pos :
Kontak Utama :
Nomor Telepon : No Fax :
Email :

CABANG 4
Tipe Business : Pet Shop DIY Stores
Nama Outlet :
Alamat :

Provinsi :
Kota : Kode Pos :
Kontak Utama :
Nomor Telepon : No Fax :
Email :
 INFORMASI CABANG

CABANG 1
Tipe business : Klinik Hewan eksklusif Klinik Hewan & Petshop
Online / E-retail Lainnya : ………………………………………………
Nama outlet :
Alamat :

Provinsi :
Kota : Kode Pos :
Kontak utama :
Nomor Telepon : No Fax :
Email :

CABANG 2
Tipe business : Klinik Hewan eksklusif Klinik Hewan & Petshop
Online / E-retail Lainnya : ………………………………………………
Nama outlet :
Alamat :

Provinsi :
Kota : Kode Pos :
Kontak utama :
Nomor Telepon : No Fax :
Email :

CABANG 3
Tipe business : Klinik Hewan eksklusif Klinik Hewan & Petshop
Online / E-retail Lainnya : ………………………………………………
Nama outlet :
Alamat :

Provinsi :
Kota : Kode Pos :
Kontak utama :
Nomor Telepon : No Fax :
Email :

CABANG 4
Tipe business : Klinik Hewan eksklusif Klinik Hewan & Petshop
Online / E-retail Lainnya : ………………………………………………
Nama outlet :
Alamat :

Provinsi :
Kota : Kode Pos :
Kontak utama :
Nomor Telepon : No Fax :
Email :
Customer Segmentation
Independent
Chains
Distributor
Association
Shelter Cat
Shelter Dog
Shelter Cat & Dog

Company Setup
Sole Proprietor
Partnership
Limited Company
Govt. Company

Channel
POS
VET
PRO

Customer Classification SPT

A Customer NT > IDR 75mio/month ; using system
B Customer NT > IDR 45mio < IDR 75mio/month ; using system
C New Customer
D Customer NT > IDR 75mio/month ; distribution; only one branch
E1
E2

Mode of Sale
Offline
Online
Mixed

Pets handled
Cats
Dogs
Both

Yes
No

Credit Days
CASH
30 Days

Payment Mode
Bank Transfer
EDC Machine
VET