Customer Information Sheet

Business Name : Date Started of

Business :
Address :

Phone Number : Fax Number :

Warehouse Address :

Phone Number : Fax Number :

Owner's Address :

Phone Number : Fax Number : Email Address :

Corporation/Partnership
SEC No. :
Documents Required
- New Reseller Form
Date Issued : - others:

Authorized Capital :

Subscribed Capital :

Paid Up Capital :

Sole Proprietorship
DTI Registration No. :
Documents Required
Date Issued : - New Reseller Form
- Others:
Amount Capital :

Paid Up Capital :

Tax Account No.

Company Officers

Designation Name Address Contact No. Email

President / Gen. Manager

Purchaser :
Accountant :
Legal Consultant :
Optional:
Accounting :
Sales (Purchasing) :
Technical:
Warehouse/Delivery :
Collection Procedure
 Countering
Required :

Yes If Yes : Countering Day :

No Collection Day :

Signature Specimens of Cheque and Contract Agreement Signatories

Name Signature Position

Authorized P.O Signatories

Name Signature Position

Trade Reference
Major Suppliers
Product Monthly Contact
Company Address Phone No. Terms Credit Limit
Purchase Purchase Person

Accredited Suppliers / Service Provider

Company Address Phone No. Services provided Contact Person

Major Clients
Product Monthly Contact
Company Address Phone No. Terms Credit Limit
Purchase Purchase Person

Bank Reference
Savings Account Branch
Bank Name Branch Phone No. Current Account No. ADB
No. Manager

Business Operations
Days : Office Delivery Schedule :
hours :
 Optional:
Number of Branches :

Name and Address :

Sketch of Office Vicinity (please attach copy if needed)

Payment Scheme

*Would you prefer online banking / payment with us?

Yes No

Products Carried/Services Offered

Terms and Condition

1. The dealer agrees to pay cash on the first transaction.

2. Terms will only be given after submitting the proper documents and after the credit investigation has taken place.

3. Only cheques with the accredited accounts specified in the Bank Reference will be accepted.

4. Delivery lead time shall depend on the availability of stock.

5. All sales are final.

I certify that all information provided above are true and correct. Accomplished this __________ day of
________________, __________.

Name : _____________________________________

Signature: ___________________________________

Designation: _________________________________

_____________________________________________________________________________________________________
For Accounting purposes :
Approved
Terms:______________________
Credit
Limit:__________________________