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Customer Application Form

This document is a customer application form containing key information about a business applying for credit or services. It requests details such as the business name, tax identification number, contact information, date established, business structure, licenses and registrations, ownership structure, key officers, subsidiaries or affiliates, top five customers and suppliers, completed and ongoing major contracts or projects, proposed credit terms and line, and bank information. The applicant certifies that the information provided is true and correct and includes required accreditation documents.

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Erica Aquino
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© © All Rights Reserved
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62 views2 pages

Customer Application Form

This document is a customer application form containing key information about a business applying for credit or services. It requests details such as the business name, tax identification number, contact information, date established, business structure, licenses and registrations, ownership structure, key officers, subsidiaries or affiliates, top five customers and suppliers, completed and ongoing major contracts or projects, proposed credit terms and line, and bank information. The applicant certifies that the information provided is true and correct and includes required accreditation documents.

Uploaded by

Erica Aquino
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CUSTOMER APPLICATION FORM

Vendee Name: Contact Person/Sales Executive:

Nature of Business: Tax Identification No.(TIN):

Contact Details: Tel. No.: Fax No.: Email: Web Site:


Date Established: No. of years in operation:
Business Structure: ☐ Single Proprietorship ☐ Partnership ☐ Corporation ☐ Others
Address Telephone No. No. of Employees
Head Office
Factory/Warehouse
Branch/es
Licenses/Registrations
DTI Registration No.: SEC Registration No.:
VAT Registration No.: Social Security No. (SSS):
Ownership
Majority Owner Nationality % of Ownership

Key Officers/Top Officials


Name Nationality Position

SUBSIDIARIES/AFFILIATES
Company Name Address Nature of Business

Top Five (5) Customers


Contact Person/
Volume of Terms of
Name Address Goods/Service Supplied Contact No./
Business/Year Payment
Email Address

Top Five (5) Suppliers


Contact Person/
Terms of
Name Address Goods/Service Purchased Credit Line Contact No. /
Payment
Email Address

NOTE: PLS. USE ADDITIONAL SHEET IF SPACE IS INSUFFICIENT.

2nd Floor Sitaldason’s Building, 2667 Honduras St., Brgy. San Isidro Makati City | Office: +632 8733.8088 | [email protected]
Completed major contracts/projects within the last 5 years
Nature of Project Owner Contact Person Tel. No. Goods/Services Offered Contract Price

Ongoing major supply contracts/projects


Contract Target
Nature of Project Owner Contact Person Tel. No. % Accomplished
Price Comp. Date

Credit Terms/Line
Proposed Credit Terms ☐ more than 45 days ☐ 45 days ☐ 30 days ☐ Others ______________ (pls. specify)
Proposed Credit Line ☐ PHP3.0 Mln ☐ PHP2.0 Mln ☐ Php1.0Mln ☐ Others ______________ (pls. specify)
Bank Information
LOCAL
Name of Bank
Address & Tel. No.
Name of Bank
Address & Tel. No.
Name of Bank
Address & Tel. No.
FOREIGN
Bank Name:
Bank Account Name:
Bank Account Number:
Bank Address:
ZIP Code:
Swift Code:
Currency:

I/We hereby certify that the information given above are to the best of my/our knowledge true and correct. Attached are the copies of the required
accreditation documents.

_____________________________________________
Printed Name over Signature

_____________________________________________

_____________________________________________
Date

2nd Floor Sitaldason’s Building, 2667 Honduras St., Brgy. San Isidro Makati City | Office: +632 8733.8088 | [email protected]

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