CUSTOMER INFORMATION SHEET

CONCEPCION CARRIER AIRCONDITIONING COMPANY

KM20 East Service Road South Superhighway
Alabang Muntinlupa City, Philippines 1700
Tel.: (632) 850-1367; 809-1882 Fax: (632) 809-9857; 809-9979

COMPANY NAME:

Legal Structure: Sole Prop Partnership Corp Non-Profit

PRINCIPAL ADDRESS:

Desired Credit Limit:

Payment Terms:

Requirements:
A. Corporation SEC Registration B. Sole Prop DTI C. Additional:
BIR 2303 BIR2303

Latest Financial Certificate of Certificate of Non-

Statement Registration Vat if Applicable

General Information Mayor's and

Sheet other Permit

Articles/By Laws ( for Latest Financial

new account) Statement

CONTACT INFORMATION : BILLING INFORMATION :

Contact Name: Accounts Payable Contact Person :
Position :
Phone : Phone:
E-Mail Address: E-mail Address:

GENERAL COMPANY INFORMATION :

Date of Incorporation:
Industry Classification:
Tax Classification: VATABLE NON-VAT
Tax NO:
Name of Officers Position
1
2
3

SISTER'S/AFFILITIATES/SUBSIDIARY:

NAME OF COMPANY ADDRESS

1
2
3

TRADE REFERENCES (LOCAL SUPPLIER)

NAME OF COMPANY TEL # PRODUCT SUPPLIED TERM CREDIT LIMIT
1
2
3
4
5
BANK REFERENCES
CONTACT
NAME OF BANK TYPE OF ACCOUNT ACCOUNT NUMBER BRANCH
PERSON
1
2
3
4

CREDIT LINE/LOANS
NAME OF BANK TYPE OF LOAN LOAN AMOUNT TERMS O/S Balance
1
2
3

By signing this form, I hereby certify that the information provided herein is true , accurate and complete,
and I agree to notify and update CCAC of any change in any of the information supplied to this form.

I hereby expressly agree , consent , authorize the company Concepcion Carrier Airconditioning Company
to conduct bank and trade checking on the above mentioned references without need of prior notice to me
and all information relating to this such as transaction history, purchases and payments,
and any obligation inclusive of the account.

This consent and authorization remains valid and subsisting unless revoked or cancelled in writing.

Customer Signature over Printed name Credit Analyst

Date:

Credit Supervisor