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: - SEC, Company Profile, BIR 2303 and Bus. Permit (optional)
   

Authorized Capital :            

Subscribed Capital :            

Paid Up Capital :    

Sole Proprietorship
DTI Registration No. :  
Documents Required
Date Issued
- New: Reseller Form            
- Others: - DTI, Company Profile, BIR 2303 and Bus. Permit (optional)
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
Bank Name Branch Phone No. Current Account No. ADB Branch Manager
No.
                         
                 
                         
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:__________________________