Credit Term Application Form

OWNER'S INFORMATION
Owner's Full Name: Owner's Contact No.:
Owner's Home Address: TIN Number
Birth Date:

BUSINESS INFORMATION
Business Name: Business Tel no.:
Business Address: Business CP no.:
Years in Business:

Type of Business: Supermarket Whole Saler Grocery Store

Sari-Sari Public Market Stall Others, Pls Specify ____________________

TOP SUPPLIERS
Supplier/Name of Company Contact Person/Designation Contact Number
1
2
3

TOP CUSTOMERS
Customer Name/Name of Business Contact Person/Designation Contact Number
1
2
3

BANK REFERENCE
BANK & BRANCH ACCOUNT NUMBER ACCOUNT NAME SIGNATURE
1
2

ATTACHMENT (PHOTOCOPY)
Kindly attach a photocopy of the following for further reference.
1. DTI Business Name Registration 4. Latest Bank Statement
2. Business Permit 5. Latest top 3 Supplier's Sales Invoices/Delivery Receipt
3. BIR Form 2303 6. Latest top 3 Customer's Sales Invoices/Collection Receipt
I hereby certify that, to the best of my knowledge, the provided information is true and accurate.

Signature over Printed Name / Date

Do not write below this line - Office use only
AGREEMENT
The Approval of this credit term will be based on the assessment of the customer's status and it is on the management's discretion whether the
application will be approved or not. Non-compliance with the approved no. of terms will result to termination of the credit term.
APPROVED NUMBER OF DAYS TERMS:
APPROVED CREDIT LIMIT:
Approved by: Customer:

Account Officer Signature over printed name / Date