CUSTOMER INFORMATION FORM
(For Distributor / Business Partner)
PART 1 – COMPANY & CONTACT INFORMATION
Company Name:
*
Owner Name:
*
Registered Address:
*
Contact Person (Authorized Representative):
*
Position:
*
Mobile Number:
*
Format: (000) 000-0000.
Telephone Number:
Format: (000) 000-0000.
Email Address:
*
example@example.com
Business Permit / License No.:
Tax Identification No. (TIN):
PART 1 – COMPANY & CONTACT INFORMATION
Nature of Business:
Wholesale
Retail
Distributor
Other
Store Name / Shop Location:
Years in Operation:
Years
PART 3 - PAYMENT & BILLING INFORMATION
Preferred Payment Method:
Bank Transfer
PDC Cheque
Payer Bank References:
Payer Bank References:
Rows
Bank branch/tel no.
ACCOUNT NAME
ACCOUNT NO.
1
2
3
PART 4 - SUPPLIER INFORMATION
Rows
Contact Person
Mobile Number
Address
1.
2.
3.
PART 5 – DELIVERY & SHIPPING INFORMATION
Delivery Address:
*
Receiving Person & Contact Number:
*
PART 6 – ACKNOWLEDGMENT & AUTHORIZATION
I hereby certify that all information above is true, accurate, and complete. I authorize the company to use this information for transaction, delivery, and warranty purposes.
Signature:
*
Printed Full Name:
*
Date:
-
Month
-
Day
Year
Date
REQUIREMENTS
PLEASE ATTACHED CLEAR IMAGES HERE
DTI/SEC
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BIR 2303
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BIR 0805 UPDATE
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MAYOR'S PERMIT (UPDATED)
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