11/1/21, 4:54 PM Form Pendaftaran NEW CUSTOMER / END USER

Form Pendaftaran NEW CUSTOMER /

END USER

Identitas Account Manager/Account Executive

1. Nama Lengkap Account Manager/Account Executive *

Bima Oriza Safitra

Data Pelanggan

2. Nama Customer di CRM *

Isi dengan Huruf Kapital, misal PT. KERETA API INDONESIA

PT ADE PUTRI MEDIKAL NUSANTARA

3. Tipe Customer (End-Customer khusus untuk segmen operator Jakarta) *

Customer

End-Customer

4. Nama Parent Account *

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Nama customer existing sebagai customer induk dari End Customer (misal, PT. MORA TELEMATIKA
INDONESIA, PT. CYBERINDO ADITAMA, PT. HIPERNET INDODATA, dll)

PT ADE PUTRI MEDIKAL NUSANTARA

End Customer

5. No. Telepon

82275157792

6. Profit Center *

SBU Sumbagut 

7. Customer Group (Segment) *

Healthcare 

8. Kategori Alamat *

Head Office

Billing (Penagihan)

Link

Shipping

9. Tipe Alamat *

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Originating

Terminating

10. Provinsi *

Sumatera Utara

11. Kota / Kabupaten *

Langkat

12. Kecamatan / Kelurahan

Tanjung Pura

13. Alamat *
Nama Jalan, Nama Gedung, Lantai, Kavling, Kawasan

JL Stabat - Tanjung Pura KM 45, Jentera Stabat Wampu

14. Kode Pos

20811

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11/1/21, 4:54 PM Form Pendaftaran NEW CUSTOMER / END USER

15. Koordinat *
Contoh: -6.261874, 106.868850

3.7556557,98.4504909

16. Contact Person (PIC) Utama *

Nama PIC

Dodi

17. Jabatan PIC *

IT Manager

18. No. HP PIC *

82275157792

19. Department PIC *

IT

Procurement

Finance

Other

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11/1/21, 4:54 PM Form Pendaftaran NEW CUSTOMER / END USER

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