CUSTOMER INFORMATION SHEET
(PLEASE FILL OUT THE REQUIRED DETAILS)
COMPLETE NAME
*
LAST NAME
FIRST NAME
MIDDLE NAME
Suffix
HOME ADDRESS
*
House Number and Street/Subdivision
Barangay
City
State / Province
Postal / Zip Code
OFFICE ADDRESS
Office Name/Building/Street
Barangay
City
State / Province
Postal / Zip Code
BIRTHDAY
*
-
Month
-
Day
Year
GENDER
*
MALE
FEMALE
CIVIL STATUS
*
SINGLE
MARRIED
DIVORCED/SEPARATED
WIDOW/ER
SPOUSE NAME (If married)
LAST NAME
FIRST NAME
MIDDLE INITIAL
Suffix
SPOUSE OCCUPATION
CONTACT NUMBER
*
Email
FACEBOOK MESSENGER
*
OCCUPATION
*
if none, please input UNEMPLOYED
LOCATION
SECTION
BLOCK
LOT
PLEASE UPLOAD YOUR VALID ID
*
Browse Files
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Choose a file
Valid ID with signature
Cancel
of
PLEASE UPLOAD YOUR SIGNATURE SPECIMEN
*
Browse Files
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Choose a file
Valid ID with signature
Cancel
of
SOURCE OF INCOME
*
Employment
Self-employed
Business
Other
MONTHLY INCOME RANGE
0-30,000
30,000-60,000
60,000-100,000
Above 100,000
PREFERRED PAYMENT OPTIONS
*
Over the counter
Website
Bank
Post-dated Cheque
M Lhuiller
Gcash
AGENT NAME
*
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PLEASE FILL IN IF THE ACCOUNT IS FINANCED BY ANOTHER PERSON
COMPLETE NAME
Last Name
First Name
Middle Name
Suffix
Home Address
House Number and Street/Subdivision
Barangay
City
State / Province
Postal / Zip Code
OFFICE ADDRESS
Office Name/Building/Street
Barangay
City
State / Province
Postal / Zip Code
BIRTHDAY
-
Month
-
Day
Year
GENDER
MALE
FEMALE
CIVIL STATUS
SINGLE
MARRIED
DIVORCED/SEPARATED
WIDOW/ER
CONTACT NUMBER
Email
OCCUPATION
if none, please input UNEMPLOYED
SOURCE OF INCOME
Employment
Self-employed
Business
Other
MONTHLY INCOME RANGE
0-30,000
30,000-60,000
60,000-100,000
Above 100,000
PAYMENT TERMS
SPOTCASH
24 months to pay @ 0% interest (with 50% downpayment)
24 months to pay @ 0% interest (No downpayment)
5 YRS STRAIGHT MONTHLY (NO DOWNPAYMENT)
3 yrs monthly amortization @ 10% interest (with 15 mos downpayment)
4 yrs monthly amortization @ 12% interest (with 15 mos downpayment)
5 yrs monthly amortization @ 12% interest (with 15 mos downpayment)
PREFERRED PAYMENT OPTIONS
Over the counter
Website
Bank
Post-dated Cheque
M Lhuiller
Gcash
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ACCOUNT BENEFICIARIES
FIRST BENEFICIARY
First Name
Middle Name
Last Name
Suffix
RELATIONSHIP TO THE BUYER
DATE OF BIRTH
-
Month
-
Day
Year
MM/DD/YYYY
2ND BENEFICIARY
First Name
Middle Name
Last Name
RELATIONSHIP TO THE BUYER
DATE OF BIRTH
-
Month
-
Day
Year
MM/DD/YYYY
3RD BENEFICIARY
First Name
Middle Name
Last Name
RELATIONSHIP TO THE BUYER
DATE OF BIRTH
-
Month
-
Day
Year
MM/DD/YYYY
4TH BENEFICIARY
First Name
Middle Name
Last Name
DATE OF BIRTH
-
Month
-
Day
Year
MM/DD/YYYY
RELATIONSHIP TO THE BUYER
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I hereby consent with the collection, use and disclosure by the Seller of all the information I have given hereunder for the purpose of processing this Purchase Agreement and all other documents related hereto.
*
Yes, I agree
Submit
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