Control No.

_________

CUSTOMER INFORMATION SHEET

CUSTOMER INFORMATION
Customer Business Name:

Customer Trade Name:

No. of Branches:

Business Address: Office Address:

Delivery Address: Delivery Date and Time:

Contact Name/Authorized Person: Two Specimen Signature: Position:

(Purchasing Dept.)
1.
2.
Contact Name/Authorized Person: Two Specimen Signature: Position:
(Receiving Dept.)
1.
2.
Contact Name/Authorized Person: Two Specimen Signature: Position:
(Accounting Dept.)
1.
2.
Telephone No : Fax No.: Email Address:

Nature of Business/Industry : No.of Years Trading in the SEC Registration No./DTI

Current Business Style: Permit No.:

Company/ Business Type: Certificate of Registration

No. (BIR 2303):
Sole Proprietorship

Partnership
VAT Registration No.
Corporation

Tax Identification No. Business Permit No.

For Partnership and Corporation, please list names and address of all partners, officers or board of
directors.

FOR PARTNERSHIPS:

Name of Partners Address TIN

FOR CORPORATIONS:

Officers Position Address TIN

Board of Directors Address TIN

Kindly continue on the appropriate space on the reverse side of this form, if necessary.

BANK REFERENCES

Institution Name: Institution Name:

Checking Account No. : Savings Account No.:

Branch: Branch:

Address: Address:

Telephone No. Fax No. Telephone No. Fax No.

TRADE REFERENCES: Please list two (2) trade suppliers with whom you are currently having
business with.

Business Name: Business Name:

Address: Address:
 Telephone No. Fax No. Telephone No. Fax No.

I acknowledge and agree that all statements and answers contained herein are full,
complete and true and bind all parties.

Name and Signature of Customer Date

and/or Authorized Representative

FOR OFFICE USE ONLY

CHECKED BY: DATE:

APPROVED BY: DATE:

ACCOUNT/ REFERENCE NO.:

ACCOUNT MANAGER: SALES AGENT:

/MSF 420.20.01Customer Information Form Oct2013