CLIENT VERIFICATION FORM As of Jan 18 2021

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RELEASE DATE : MODE OF TRANSACTION :

CLIENT NAME : FINANCING INSTITUTION :

EMAIL ADDRESS : TAX IDENTIFICATION NO :

INVOICE NO. : PHONE/MOBILE NO. :

UNIT : SALES CONSULTANT :

AMOUNT MATCH NOT MATCH REMARKS

UNIT AMOUNT :

UNIT DISCOUNT

RESERVATION :

FULL DP AMOUNT :

DP DISCOUNT :

INDICATE IF FREE OR PAID

CHATTEL :

INSURANCE :
INSURANCE CO:

LTO :

ACCESSORIES : INDICATE SPECIFIC ITEMS


- FREE

- PAID

- ALREADY INSTALLED / GIVEN

- TO FOLLOW / FOR INSTALLATION

ESTIMATED DATE OF INSTALLATION


/ PROVISION PER SC: _____________

CLIENT SIGNATURE :

VERIFIED BY : :
(SIGNATURE OVER PRINTED NAME) DATE OF VERIFICATION

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