Calderon Bldg.

, 827 EDSA, South Triangle, Quezon City

DEALER / PARTNER APPLICATION FORM

GENERAL INFORMATION
REGISTERED BUSINESS NAME BUSINESS PHONE NO.

BUSINESS ADDRESS BUSINESS FAX NO.

WEBSITE EMAIL ADDRESS

RESIDENCE ADDRESS RESIDENCE PHONE NO. CELLPHONE NO.

BUSINESS STRUCTURE NATURE OF BUSINESS

SOLE PROPRIETORSHIP CORPORATION PARTNERSHIP TRADING SERVICE CONTRACTOR OTHERS: __________________________
NO. OF EMPLOYEES BUSINESS ESTABLISHMENT YEARS IN OPERATION
REGULAR: ___________ PROBATIONARY: ___________ CONTRACTUAL/PROJECT BASIS: __________ OWNED RENTED LEASE

FORM OF ORGANIZATION
CAPITALIZATION DTI REG. NO. DTI DATE OF REG.

NAME OF OWNER NAME OF SPOUSE

SINGLE
PROPRIETORSHIP
SPOUSE'S EMPLOYMENT

PAID-UP CAPITAL DTI REG. NO. DTI DATE OF REG. SEC REG. NO. SEC DATE OF REG.

NAME OF PARTNER TEL. NO. ADDRESS

PARTNERSHIP

NAME OF PARTNER
TEL. NO. ADDRESS

AUTHORIZED CAPITAL SUBSCRIBED CAPITAL PAID-UP CAPITAL SEC REG. NO. SEC DATE OF REG.

CORPORATION
NAME OF OFFICERS/DIRECTORS, DESIGNATION/POSITION, RESIDENCE ADDRESS

(See attachment for list)

LIST OF AFFILIATED COMPANIES AND SUBSIDIARIES

BUSINESS NAME NATURE OF BUSINESS NO. OF YEARS ADDRESS

LIST OF PRODUCTS AND SERVICES

PRODUCT / SERVICE BRANDS, IF ANY NO. OF YEARS IN ENGAGEMENT

LIST OF FINISHED / ON-GOING PROJECTS (If Applicable)

CONTRACT CONTACT
NAME OF PROJECT AMOUNT LOCATION CONTACT NO. PERSON

BANK REFERENCES
BANK NAME BRANCH/ADDRESS ACCOUNT NO. NATURE OF ACCOUNT TELEPHONE NO. CONTACT PERSON
 TRADE REFERENCES (For the last three (3) years)
CONTACT CREDIT
NAME OF SUPPLIER ADDRESS CONTACT NO. PERSON LIMIT

PERSON WHO WILL SIGN THE CHECK PAYMENTS

FULL NAME DESIGNATION/POSITION SPECIMEN SIGNATURE

AUTHORIZED PERSON TO SIGN PURCHASE ORDER / CONTRACT / PROPOSAL

FULL NAME DESIGNATION/POSITION SPECIMEN SIGNATURE

AUTHORIZED PERSON TO RECEIVE GOODS/DELIVERIES

FULL NAME DESIGNATION/POSITION SPECIMEN SIGNATURE

PRINCIPAL OFFICERS
DESIGNATION/POSITION FULL NAME CONTACT NO.

President / CEO

Accounting Manager

Treasury Manager

Purchasing Manager

REQUIRED DOCUMENTS
FOR SOLE PROPRIETORSHIP / PARTNERSHIP FOR CORPORATION
DTI Certificate of Registration Financial Statement (if any) SEC Certificate of Registration Financial Statement (if any)
with Articles of Incorporation
Mayor's Business Permit Bank Statement Bank Statement
VAT Registration Company Profile Mayor's Business Permit Company Profile
Article of Co-Partnership 2 Gov't. IDs for Owner or Partners VAT Registration 2 Gov't. IDs for Pres., Gen. Mgr. & Treas.

We certify that the information in this form is true and correct and we hereby authorize MULTI-LINE to conduct verification on my bank status
for my application for credit terms as required in our business together.
PRINTED NAME SIGNATURE POSITION DATE
 OFFICERS / DIRECTORS OF ORGANIZATION (IF CORPORATION)
NAME OF OFFICERS / DIRECTORS DESIGNATION / POSITION RESIDENCE ADDRESS