CUSTOMER DATA SHEETL Please complete all sections of this form and select appropriate options. Customer (Required) New CustomerExisting, Info Changes Only Section I - Company Profile Information BIR Registered Business Name (Required) Trade Name (Store Name) (Required) Business Landline Number/s (Required) Fax Number/s (Required) Business Mobile Number (Required) Business E-mail Address (Required) Business Type (Required) Sole PartnershipPartnershipCorporation Industry Segment (Required) Quick Service RestoLocal BakeryRestaurantCommissariesCafeHotelBed & BreakfastResortDealer / ResellerConcessionaires Tax Identification Number (TIN) (Required) VAT (Required) With VATNon-VATVAT-ExemptedZero-Rated VAT Registration No. (Required) Section II - Delivery Address Unit No./House Number (Required) Street (Required) Barangay (Required) City (Required) Province (Required) District / Region (Required) Postal Code (Required) Section III - Billing Address Unit No./House Number (Required) Street (Required) Barangay (Required) City (Required) Province (Required) District / Region (Required) Postal Code (Required) Section IV - Point Person Information Name (Required) Birthdate (Required) Contact Number (Required) Position (Required) Signature (Required) -+ Section V - Authorized Representative Warehouse Name (Required) Contact Number (Required) Designation (Required) Signature (Required) Accounting Name (Required) Contact Number (Required) Designation (Required) Signature (Required) Purchasing Name (Required) Contact Number (Required) Designation (Required) Signature (Required) Others Name (Required) Contact Number (Required) Designation (Required) Signature (Required) Section VI - Billing & Collection Issues Required Billing Attachments (Required) Countered InvoicePurchase OrderDelivery NoteOthers Others, Please specify: (Required) Other Billing Requirements: (Required) Method of Payment: (Required) Check Pick UpBank TransferCOD Check pick up at: (Required) Preferred Collection Days (Required) MondayTuesdayWednesdayThursdayFriday Required Collection Documents (Required) Collection ReceiptCompany IDCertification, please specifyOthers, please specify Please specify: (Required) Other Collection Instructions (Required) Section VII - Declaration I hereby declare that the information given above and in any documents attached or requested by HICAPS Marketing Corporation in relation to this declaration is to the best of my knowledge is true, correct and complete in every respect. I hereby understand that non-disclosure/falsification of information as herein required shall be grounds for the termination of credit terms once approved and/or legal action against me / us. Name (Required) Designation (Required) Date (Required) Signature (Required) Section VIII - Attachements Photocopy of 2 valid government issued id of the Owner/Officer-In-Charge/Authorized Signatory (Required) Photocopy of Business Permits (DTI, SEC Registration, Mayor’s Permit) (Required) Certificate Of Registration (Form 2303) (Required) Proof of billing (electric bill, water bill, etc.) (Required) PLEASE WAIT FOR THE CONFIRMATION MESSAGE BEFORE CLOSING. SUBMISSION MAY TAKE LONGER DEPENDING ON THE ATTACHEMENT/S FILE SIZE.