Credit Terms Application Form

OWNER'S INFORMATION
Owner's Full Name: Owner's Contact No.:
Owner's Home Address: TIN Number
Birth Date:

BUSINESS INFORMATION
Business Name: Business Tel no.:
Business Address: Business CP no.:
Years in Business:
Type of Business: Supermarket Whole Saler Grocery Store
Sari-Sari Public Market Stall Others, Pls Specify ____________________

TOP SUPPLIERS
Supplier/Name of Company Contact Person/Designation Contact Number
1
2
3

TOP CUSTOMERS
Supplier/Name of Company Contact Person/Designation Contact Number
1
2
3

BANK REFERENCES
BANK/BRANCH ACCOUNT NUMBER ACCOUNT NAME SIGNATURE
1
2

ATTACHMENT (PHOTOCOPY)

Kindly attach photocopy of the following for further reference.

DTI Business Name Registration Latest Bank Statement
Business Permit Latest top 3 Supplier's Sales Invoices/Delivery Receipt
BIR Form 2303 Latest top 3 Customer's Sales Invoices/Collection Receipt

I hereby certify that, to the best of my knowledge, the provided information is true and accurate.

Signature over Printed Name

AGREEMENT

The Approval of this credit term will be based on the assessment of the customer's status and it is on the management's discretion
whether the application will be approved or not. Non-compliance with the approved no. of terms will result to termination of
credit terms.

APPROVED NUMBER OF DAYS TERMS:

APPROVED CREDIT LIMIT:

Approved by: Customer:

Signature over printed name