FORM CUSTOMER (A)

DI ISI OLEH CUSTOMER

FILLED BY CUSTOMER
NAMA PERUSAHAAN* :
COMPANY NAME*
KANTOR :
OFFICE
ALAMAT :
ADDRESS
Jalan/RT/RW/Blok :
Street no / Block

Gedung / Lantai :
Building/Floor

Kota / Provinsi / Kode Pos :

City / State / ZIP Code

NO TELEPON :
TELEPHONE NO.
NO FAX :
FAX NO.
ALAMAT e-MAIL :
e-MAIL ADDRESS

WEBSITE :
WEBSITE
ALAMAT PENAGIHAN* :
(Diisi jika berbeda dengan kantor)
COLLECTION ADDRESS*
(Filled if different with office address)
Jalan/RT/RW/Blok :
Street no / Block

Gedung / Lantai :
Building/Floor
Kota / Provinsi / Kode Pos :
City / State / ZIP Code

HARI TUKAR FAKTUR* : Senin Selasa Rabu Kamis Jumat Sabtu

INVOICE HAND OVER DAY* Monday Thursday Wednesday Tuesday Friday Saturday

HARI PENAGIHAN* : Senin Selasa Rabu Kamis Jumat Sabtu

COLLECTION DAY* Monday Thursday Wednesday Tuesday Friday Saturday

N.P.W.P ** :
TAX ID NO **
NAMA NPWP :
TAX ID NAME
ALAMAT NPWP :
TAX ID ADDRESS

JENIS USAHA & BRAND*** :

TYPE OF BUSSINESS & BRAND***
Klasifikasi Lapangan Usaha (KLU)* :
Business Field Classification (KLU)*
KEPEMILIKAN :
OWNERSHIP
ALAMAT PABRIK :
(Diisi jika berbeda dengan kantor)
COLLECTION ADDRESS
(Filled if different with office address)
Jalan/RT/RW/Blok :
Street no / Block

Kota / Provinsi / Kode Pos :

City / State / ZIP Code

Dok No: FORM - MKT- 005 REV.1

KONTAK PERSON :
CONTACT PERSON
PURCHASING1 :
PURCHASING1
No Handphone & alamat email :
Handphone No & email address
PURCHASING2 :
PURCHASING2
No Handphone & alamat email :
Handphone No & email address
FINANCE/ACCT :
FINANCE/ACCT
No Handphone & alamat email :
Handphone No & email address
DIREKTUR/PEMILIK :
DIRECTOR/OWNER
No Handphone & alamat email :
Handphone No & email address
KONTAK PERSON LAINNYA :
OTHER CONTACT PERSON
No Handphone & alamat email :
Handphone No & email address

JANGKA WAKTU PEMBAYARAN* : HARI MATA UANG : RP USD RP & USD

TERM OF PAYMENT* DAYS CURR : IDR USD RP & USD

TOTAL PEMAKAIAN : TON/BULAN

TOTAL USAGE TON/MONTH
JENIS PEMBAYARAN* : TRANSFER GIRO
TYPE OF PAYMENT* BANK TRANSFER BANK DRAFT

ALAMAT PENGIRIMAN BARANG :

(Diisi jika berbeda dengan kantor)
DELIVERY ADDRESS
(Filled if different with office address)
Jalan/RT/RW/Blok :
Street no / Block

Kota / Provinsi / Kode Pos :

City / State / ZIP Code

KONTAK PERSON GUDANG :

FACTORY CONTACT PERSON
No Handphone & alamat email :
Handphone No & email address

CATATAN :
NOTE
________________,_______________

DIBUAT OLEH, DIKETAHUI OLEH

CREATED BY, APPROVAL BY,

Nama : ________________ Nama : __________________

Name Name
Jabatan : PURCHASING Jabatan : DIREKTUR/PEMILIK
Position : PURCHASING Position : DIRECTOR/OWNER
Dok No: FORM - MKT- 005 REV.1
*) & cetak tebal : Harus diisi
*) & bold : Must filled the blank

**) Mohon melampirkan fotocopy NPWP & & Surat Pengukuhan Pengusaha Kena Pajak
Please attach of copy NPWP & Surat Pengukuhan Pengusaha Kena Pajak

Perusahaan berstatus Kawasan Berikat Nusantara, melampirkan surat persetujuan Menteri Keuangan
***)
Company located in Bonded Zone, please attach Surat Persetujuan dari Menteri Keuangan