phone: +63 2 521 7392

fax: +63 2 525 5009

email: contact@artisan.com.ph

Client Information Form

Business Name:___________________________________ Year Started in Business:_________
Business Address:___________________________________________ TIN #_______________
Email Address:____________________________________ Mobile Number:________________
Office Telephone Number:__________________________ Fax Number:___________________
Company Representative:___________________________ Number of Employees: __________

Company Business TIN Number:____________________________________________________

DTI/SEC Certificate Number:________________________________________ with attachment
Mayor’s Permit Number:___________________________________________ with attachment
BIR Registration Number:___________________________________________ with attachment

Payment Releasing Personnel: _______________________

Collection Schedule: _______________________________
Monthly Sales/Consumption: ________________________

List of Branches:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Company Officials:
Name: Designation: Telephone Number:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Business Credit References (Please Include Bank):

Name of Bank: Branch Address: Account Type: Account Number: Credit Line:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

18th Floor Ramon Magsaysay Center Roxas Blvd., Manila 1000 Philippines
 phone: +63 2 521 7392
fax: +63 2 525 5009
email: contact@artisan.com.ph

Name of Major Suppliers:

Name of Supplier: Address: Telephone Number: Credit Line:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Affiliated Companies or Subsidiaries:

Name: Address:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Authorized signature for Delivery Receipt/Sales Invoice:

Positio
Name n Signature

I hereby certify that all data in this application are true and correct to the best of my knowledge
and allow Artisan Cellars and Fine Foods Inc and its authorized representative to verify and
conduct investigation on the information given as may be required.

APPLIED FOR THE COMPANY BY:

_______________________________
President or Senior Officer
(Signature over Printed Name)

18th Floor Ramon Magsaysay Center Roxas Blvd., Manila 1000 Philippines