AMERICAN TECHNOLOGIES INC.

TGRAF INC.
LICIADA INNOVATIONS INC. BULACAN
SUPERFAB INCOPORATED -
XURETAIL ENT

No. 5 Ideal St.cor. McCollough, Brgy. Addition Hills Mandaluyong City Tel. No. 8 5840000 Accounting Dept. Fax No. 8 584-5542

CUSTOMER INFORMATION SHEET ( ) NEW ( ) UPDATE

Documents Required: (Please Fax) Other Documents Required: (Optional)
1. Company Profile 1. PEZA registered companies
2. Latest Audited Financial Statement Certificate of Reg'n. issued by PEZA
3. BIR Registration (BIR Form# 2303) PEZA ERD Form No. 97-01 & or 03-01
4. DTI Registration and SEC Registration - front page only w/ Reg'n. No. 2. For Vat-Exempt companies
5. Articles of Incorporation and Gen. Information Sheet Special ruling issued by BIR stating that your
(pages showing List of Stockholders & Shares of Stocks only) company is vat-exempt on its local purchases
6. Authorization Letter to facilitate Credit Investigation w/ your banks & of goods/services
7. Latest Bank Statement (at least 2 months) and other proof of income 3. For locators of Subic, Clark & Bataan Freeport Zones
8. Photocopy of two (2) valid govt id's of authorized signatories Endorsement issued by the freeport zones

Customer Information:
Company Name:
Company Address:

Applicant's Name:
Designation:
Telephone Numbers: Fax No.: Cellphone No.
E-mail Address: Tax Code: ( ) VAT ( ) NON-VAT
TIN No.: ( ) ZERO RATED ( ) VAT-EXEMPT
Nature of Business: DTI/SEC Registration No:

Collection Information: (Please indicate AS ABOVE if it is the same as Customer Information)

Collection Address:
Contact Name:
Designation:
Telephone Numbers: Fax No.:
E-mail Address: Cellphone No.:
Collection Schedule:

IMPORTANT: (FOR PURPOSES OF SPECIMEN SIGNATURE/S VERIFICATION ONLY)

AUTHORIZED SIGNATORIES (PURCHASING)
NAME DESIGNATION SIGNATURE

NOTE: FOR PURCHASE ORDER

AUTHORIZED SIGNATORIES (FINANCE)
NAME DESIGNATION SIGNATURE

NOTE: FOR CHECK DISBURSEMENT/PAYMENTS

Credit Information: (Fill-up at least three references)

Bank 1 Bank 2 Bank 3 Bank 4
Name:
Branch:
Account Name:
Account No.:
Contact Name:
Designation:
Telephone No.:
Years in Dealing:
Supplier 1 Supplier 2 Supplier 3 Supplier 4
Name:
Merchandise Supplied:
Contact Name:
Designation:
Telephone No.:
Credit Terms:
( To be filled-up by OFFICERS OF ATI & it's affiliated companies)
Approved Credit Limit Approved Credit Terms
Approved Mode of Payment ( )CASH ( )COMPANY CHECK ( )MC/MANAGER'S CHECK ( ) REMITTANCE/TEL. TRANSFER
REMARKS:

Approved by & Date:

LENI MERLIE B. MACALALAD

VP - Finance