NKG Indonesia Imports - New Client Form

Company Name* This field is required.This will be the entity/name reflected in our invoices and other documents

(e.g. PT ABC Coffee Company)

Estimated Annual Green Coffee UsageCumulative yearly coffee roasted. Estimated if unknown.

in Kilograms

Registered Business Address* This field is required.Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Business Type* This field is required.

Coffee Roaster

Reseller

Other

Company Website

e.g. nkgindonesiaimports.com

Company SizeTotal employyes

e.g. 10

Paid-Up CapitalIn US Dollars

e.g. 10,000

Prior Year RevenueIn US Dollars

e.g. 100,000

Delivery Address* This field is required.Primary address of destination of coffee beans.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Primary Contact* This field is required.

First Name

Last Name

Job Title

Primary Contact Office Phone Number

Country Code (e.g. +65)

Phone Number

Primary Contact Mobile Phone Number* This field is required.

Country Code (e.g. +62)

Phone Number

Primary Contact Email Address* This field is required.

example@example.com

Preferred Communication Medium* This field is required.Preferred mode of communication

Skype

WeChat

Viber

Zalo

SMS

Phone Call

Other

Accounts Department Contact

Prefix

First Name

Last Name

Accounts Phone Number

Country Code (e.g. +65)

Phone Number

Accounts Mobile Number

Country Code (e.g. +65)

Phone Number

Accounts Email

example@example.com

Authorized Signatory Name* This field is required.

Prefix

First Name

Last Name

Job Title (e.g. Director)

Authorized Signature* This field is required.

Clear

Would you like to be included in our Price and Stock List Updates?* This field is required.Market information, latest arrivals, latest spot offers, announcements and others will be included in the blast

YESNO

Please Upload a copy of your NPWPIf you do not have one or unsure, your appointed Trader from NKG Indonesia Imports will contact you.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

(e.g. NPWP pdf file)

NKG Indonesia Imports - New Client Form