CUSTOMER INFORMATION SHEET (CIS)

Area:
Date:
COMPANY INFORMATION:

Business Name:
Business Address: Postal Code:
(Maximum of 35 characters including space)
Phone: Fax:
E-mail: Website:
Warehouse Address:
Warehouse Tel: Fax:

Business Ownership: Corporation Partnership Single Proprietorship

Nature of Business: Dealership Trading Distributorship

Retail & Wholesaler

Year Established: Capitalization:

Other Business Ventures:
Affiliated Associations:

ADDITIONAL INFORMATION:

Store / Office: Owned Leased Total Area:

Warehouse: Corporation Partnership Total Area:

No. of Delivery Vans:

Total No. of Employees: No. of Marketing Personnel:

Major Officers / Official Representatives:

Name Title / Position Years with Company
1.
2.
3.

Sales / Distribution Method: Agent Concessionaire Consignment

Outright Store

Merchandise Category: Gen.Mdsg. Hardware Electrical

Construction Supplies Others

Average Monthly Gross Sales: PhP

Coverage of Sales Area:

Dealer of: No. of Years:

Dealer of: No. of Years:
Dealer of: No. of Years:
 CUSTOMER INFORMATION SHEET (CIS)
PERSONAL INFORMATION:

Name (English): (Chinese):

Address:
Telephone No: Cellphone No.:
E-mail:
Age: Marital Status: No. of Children:
Name of Spouse (English): (Chinese):
Educational Attainment:
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BANK INFORMATION:

Bank / Branch Account Name Account No. Signatories

1.
2.
3.

SUPPLIER’S INFORMATION:

Company / Address Tel. / Fax Ave. Monthly Credit Limit

Purchases & Terms
1.
2.
3.
4.
5.

Submitted By:

Applicant’s Signature over Printed Name Date

REQUIREMENTS:
Please put a check mark on documents submitted:

1pc 2x2 Photos of Applicant SEC Registration

Business Name Registration Tax Identification No.
Community Tax Certificate (CTC) Income Tax Return
Municipal License Permit Financial Statement
Corporate General Information Vicinity Map
Bank Authorization Letter PEZA Accreditation

AUTHORIZATION

This is to authorize YATAI INTERNATIONAL CORPORATION to acquire the following pertinent information related to my bank
and loan credit standing.

This is in connection with my application for a credit line with YATAI INTERNATIONAL CORPORATION. Thank you.

Name of Company:
Printed Name:
Signature: