GENERAL GUIDELINES:

1. FIELDS WITH ASTERISK SIGN (*) ARE REQUIRED.

2. PLEASE INPUT N/A IF NOT APPLICABLE.
Antonio Drive Cor., Sitio Sta. Maria Industrial Estate 3. TICK THE BOX THAT CORRESPONDS TO SUBMITTED DOCUMENTS.
Bagumbayan, Taguig City, Philippines
Tel. No. 8551-5691, 8838-8883, 8837-0500

CUSTOMER INFORMATION SHEET

To be filled-out by customer

GENERAL INFORMATION
Registered Company Name*
Trade Name*
Business Address*
Telephone/Fax Number* Website/Email*
Date Business Started* Nature of Business*
TIN Number* Delivery Address*

KEY PERSONNEL
Title/Position Name Residence Address Contact No. Nationality

President*

VP-Finance*

Purchasing Manager*

Accountant*

Treasurer*

Follow-up Payment*
BANK REFERENCES (Please provide at least 1)
Bank Name* Bank Name

Branch* Branch

Account No.* Account No.

Bank Address* Bank Address

Telephone Number* Telephone Number

OTHER SUPPLIER REFERENCES

Company Name 1* Telephone Number*

Address* Contact Person*

Company Name 2* Telephone Number*

Address* Contact Person*

Company Name 3* Telephone Number*

Address* Contact Person*

Gover
Private
CLASSIFICATION OF BUSINESS* TERMS OF PAYMENT* (subject for approval) MODE OF PAYMENT*

nment COD
7 Bank
Check
Corporati
Indivi 15
30 Cash
Gcas
Deposit/R
Vat
Zero
on Days
dual Days
Days h
emittance
Exem
Rated BIR
Certifica
SEC
Sales
pt Invoice Certific
Certificate
for ofof
REQUIRED DOCUMENTS* (provide the documents that applies to your business)

Latest
Certific DTI-
Articles
tion Customer Channel: c/o agent*
GIS-Other
Latest
from ation
Registration
Certificate
1st Channel:

Business
ate
General Incorporati
Zero 2nd Channel:
Financial
Supplier for
-Rated
2303
of Vat
on & By
Permit
Information
Report Exempt
Registratio
Laws
Sheet n
Antonio Drive Cor., Sitio Sta. Maria Industrial Estate
Bagumbayan, Taguig City, Philippines
Tel. No. 8551-5691, 8838-8883, 8837-0500

COLLECTION AND COUNTERING*

Same as
Address of countering:* Same as
Address of Collection:*

delivery delivery
Mo
We
Tue
address
address Mon
Countering Schedule:*
Wed
Tues
Collection Schedule:*

day
Time:*
nda
Thu
dne
sda
Time:*

Thur
nesd
day y
Frid
Satu
sday
ay ySat
Frid
rsda
sda
ay
N/A
rday urd
ay
yN/A
ay
AGREEMENT

I/We warrant that all information provided in this application is true and correct. I/We authorize SANITARY CARE PRODUCTS ASIA INC its assigns
authorized verify the representative to verify accuracy of the information contained in this application and to collect information on me/us including but
not limited to bank references, trade credit references, and/or commercial credit reports.

I/We agree to abide by the payment terms established by SANITARY CARE PRODUCTS ASIA INC that these payment terms, extension and
continuation of credit facilities shall be at the sole discretion of SANITARY CARE PRODUCTS ASIA INC depending on my account creditworthiness.

I/We agree that in the event of late payment SANITARY CARE PRODUCTS ASIA INC may charge and I/We agree to pay a finance charges on the
overdue balances maximum of 3% per month. Further, in the event that the account is in default, I/We agree to pay all collection cost, Attorney's fee
and court costs incurred by SANITARY CARE PRODUCTS ASIA INC to collect the outstanding funds.

Accomplished by:*

SIGNATURE OVER PRINTED NAME

Designation:*
Date:*

Please do not write beyond this line. For SCPA use only

Endorsed by: Pre-checked by:

SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

Sales Specialist/Consultant Credit & Collection Officer
Date: Date:

Noted by: Approved by:

SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

Sales Manager Credit & Collection Manager
Date: Date: