Document ID: QSP 7.

1-01
Section: 7.1
Issue Date: 20 May 2020

Revision No: 1
Page 1 of 1
CUSTOMER INFORMATION FORM Approved by: Quality Manager

CUSTOMER/COMPANY
Registration No (or RSA ID No)

VAT number

TECHNICAL INFORMATION for Reports

Contact Person
TECHNICAL

Address for report

Telephone No

Mobile No

Email for Reports

ACCOUNTING INFORMATION for Statements and Invoices (if different to above)

Company Name for Invoice
FINANCIAL

Contact Person

Address for invoice

Email for invoice

Email for statement

Purchase Order needed before work may proceed? Yes / No

Do you want to open an account? Yes / No (All first work is strictly on COD basis)

Name

Designation

Date Authorised Signature

By signing this form, I confirm that I have read and accept the UIS Analytical Services Terms and Conditions of Services
(QSP 7.1-02), and that I am a duly authorized signatory for the company.
For office use only:

Captured by Date Signature

Submitted to Accounts Yes / No Comment(s)