Ref. No.

: Date:
CUSTOMER INFORMATION SHEET Type of Account:
COMPANY NAME : ___________________________________
EMAIL ADD: ________________________________
T.I.N. NUMBER : _____________________________________________________
BUSINESS ADDRESS : _____________________________________________________
TEL. NO(S). : ___________________________________
MOBILE NO.: ________________________________

CONTACT PERSON(S): NATURE OF BUSINESS:

NAME POSITION TEL. / CELL NO(S). Developer
1. ___________________________ ________________________ __________________________ Contractor / Engr.
2. ___________________________ ________________________ __________________________ Trader / distributor
3. ___________________________ ________________________ __________________________ Dealer
4. ___________________________ ________________________ __________________________ End User

CIS FORM FILE

 Ref. No.: Date:
CUSTOMER INFORMATION SHEET Type of Account:
COMPANY NAME : ___________________________________ EMAIL ADD: ________________________________
T.I.N. NUMBER : _____________________________________________________
BUSINESS ADDRESS : _____________________________________________________
TEL. NO(S). : ___________________________________ MOBILE NO.: ________________________________

CONTACT PERSON(S): NATURE OF BUSINESS:

NAME
1. ___________________________
2. ___________________________
3. ___________________________
4. ___________________________
POSITION
________________________
________________________
________________________
________________________
TEL. / CELL NO(S). Developer
__________________________ Contractor / Engr.
__________________________ Trader / distributor
__________________________ Dealer
__________________________ End User

AFFILIATES / OTHER BUSINESS:

Company Name Business Address Nature of Business Contact No(s).
1
2
3
4
5

TRADE CREDIT REFERENCE (S): - Please state at least 5 MAJOR SUPPLIERS: - Please fill-up completely
Company Name Product(s) Purchased No. of years Contact Person Contact No(s).
1
2
3
4
5

DEPOSITORY BANK REFERENCE (S): - Please fill-up completely together with your Letter of Authority
Name of Bank Type of Account Account Number Branch Contact Person Contact No(s).
1
2
3
4
5

FOR SINGLE PROPRIETORSHIP:

Residence address Contact No(s)
Owner's Name: ______________________ ____________________________ _______________________
Name of spouse: ______________________ ____________________________ _______________________

FOR PARTNERSHIP / CORPORATION ( Name of Partners / Key Management Personnel / Officers / Directors)
Name Position Residence Address Contact No(s).
1
2
3
4
5

CIS FORM FILE

 LETTER OF AUTHORITY

To: Bank Branch Manager / Officer - In - Charge:

Please provide NL ROOFING SOLUTIONS INC. or, any of its authorized representative with all the information
that may require regarding my / our bank account, including the following:

(a) Date Opened

(b) Average Daily Balance (ADB)
(c) Type of Credit Facility and Credit Line ( if any )

I / We understand that this instruction to give them information about my / our bank account (s) which they
undertake to use solely for determination of my credit standing will constitute my / our waiver of our rights to bank
secrecy law.

Your attention on the matter is highly appreciated.

________________________________________________
Bank Signatory / President / Gen. Manager
( Signature over Printed Name )