New Customer

For cash paying customers you can fill-up the form below. | For Check and Credit Card paying application, you can download the form here.

CUSTOMER BASIC DATA

    
Trade Name: Date:
Address: Tel. #
Store Name
( If different ): 		Fax #
Contact Person: Cel. #
Email Address:    
Tin No.    
     
Type of Business: Sole Proprietor    
  Partnership    
  Corporation    
       
Store Classification: (Retail) Supermarket    
Grocery    
  Sari Sari    
  Market Stall    
  Drug Store    
  Convenience Store    
  Wholesale / Sub D    
       
Outlet Classification: (Food Service) Bakery Source    
Local Eatery    
  Restaurant    
  Coffee Shop    
  Bars / Nightclub    
  Food stall / Fast Food    
  Food Court    
  Convenience Store    
  Hotels    
  Caterers    
  Canteens    
  Sports / Country Club    
  Shipping Line    
  Wholesaler    
  Manufacturing    
  Others :    
       

*OWNER'S INFORMATION:

   
Name: Tel. # (Res):
Address (Residence) :    
Birthday:    
       

*Person Authorized to Purchase / Sign Purchase Order (different from Owner):
Name: Cel. # :
Position:    
Birthday:    
Purchase Limit: Php:    
       
Name: Cel. # :
Position:    
Birthday:    
Purchase Limit: Php: