Dokumen # :

CUSTOMER INFORMATION FORM SS3.16-01 (00)

ACE Hardware Indonesia Kawan Lama Internusa Office Solutions
Foods Beverages Indonesia Kawan Lama Sejahtera Toys Games Indonesia
Home Center Indonesia Krisbow Indonesia Others: ................................
Create Change Extend Customer Code :

CUSTOMER PROFILE
(COMPLETED by CUSTOMER)

Company Name :
Company Group :
Address :

City : Zip Code Country

Phone : Fax

Email : Website

NPWP No. :

NPWP Address :
PKP : No Yes, No. : Date :
Type of PKP : EPTE/Kawasan Berikat WAPU Non-WAPU Other
Notes: Please attach copy of NPWP and SPPKP

BILLING INFORMATION
(COMPLETED by CUSTOMER)

Same as company`s address : No Yes (if no, fill in below information)

Billing Address :

City : Zip Code Country

Phone : Fax Email

Required Document : Original invoice Receipt/kwitansi
for Invoicing Faktur pajak
Original Copy
Delivery Note BAST Wet stamp on delivery GRN (Good Receive Note)
Others
Tukar faktur schedule : Last invoice receive date :
Payment schedule :
Type of payment : Transfer Giro Corporate Card Other
No. : - - -
Bank Name Bank Branch Account Number Account Name

SHIPPING INFORMATION
(COMPLETED by CUSTOMER)

Same as company`s address : No Yes (if no, fill in below information)

Shipping Address (1) :

City : Zip Code Country
Shipping Address (2) :
City : Zip Code Country
Required Document : Original DO Copy PO Surat Timbang
for Delivery
BC40 MSDS Others
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 COMPANY INFORMATION (COMPLETED by CUSTOMER)

Customer Type : End User Supplier Agent Distributor Manufacturer Retailer

(Attribute 1)
Government Other

Line of Business : Main Product

Year of Established : Number of Employee

Building ownership : Owned Rent Other

Revenue per year : 0 - 1M > 1M - 10M > 10M - 100M > 100M
(IDR)
Annual Purchase : 0 - 50 Juta 50 Juta - 200 Juta
estimation (IDR)
> 200 Juta - 500 Juta > 500 Juta
Have you ever purchased any product at Kawan Lama : Yes No
CONTACT PERSON (COMPLETED by CUSTOMER)

Dept./Div* Name* Direct Phone & Ext.* Mobile Phone* Email*

Finance and
Accounting
Warehouse
Purchasing
Owner

(*) Mandatory
20

( (
Customer
COMPLETED by KAWAN LAMA GROUP

Company Code / : Distribution Channel :

Sales Org
Customer : New Existing Rebate Customer Pricing Strategy :
Account Group :
Payment Term : Days (..................) Currency :

Language :
Account Type : Regular Account Big Account Potential Key Account Key Account
National Key Account
POD : Yes, reason
(Proof of Delivery) No
Transportation Zone :
Customer Type : Sister Company End User TPK Franchise E-Commerce
(For Delivery Purpose -
Attribute 2)
Proposed by: Reviewed by: Input by:
Date : Date : Date :

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