PHOENIX PETROLEUM PHILIPPINES, INC.
CUSTOMER APPLICATION FORM
IMPORTANT: Please fill - out this application form completely.
Application Type: Business Ownership Type: Distribution Channel: VAT Classification:
☐Cash Before Delivery ☐Sole - Proprietorship ☐Government ☐Vatable Sales
☐Check on Delivery ☐Commercial & Industrial ☐VAT Exempt Sales
☐Retail
☐Lubricants Distribution ☐Zero Rated Sales
☐Partnership
CORPORATE / INDIVIDUAL DATA
☐Credit ☐Corporation
Registered Business Name Tax Identification No. (TIN)
Registered Business Address City
Province Country Postal Code
Email Telephone No. Fax No. Mobile No.
* for Commercial and Lubes Distributors only
Years in Business Nature of Business Area of Operation
SEC Registration No. (if applicable) No. of Branches Parent Corporation (if subsidiary)
* for Retail/Dealership Applicants only
Name of Applicant (Dealer) Date of Birth Nationality
Civil Status Name of Spouse (if married)
Home Address City
Province Country Postal Code
Address of Proposed Station City
Province Country Postal Code Lot Area
BANK & TRADE REFERENCE
Creditor/Depositor Bank (please specify Branch) Telephone Fax Contact Person (designation)
1.)
2.)
3.)
4.)
5.)
Major Suppliers (e.g. supplier of petroleum products) Telephone/Fax Credit Line/Payment Term Contact Person (designation)
1.)
2.)
3.)
4.)
5.)
OTHER RELEVANT INFORMATION
Financial Standing (in Php )
Total Assets Current Assets Non - Current Assets
Total Liabilities Current Liabilities Non - Current Liabilities
Stockholders Equity / Capital Annual Gross Income Annual Net Income
Phoenix Petroleum Philippines, Inc.
Customer Application Form Main Office: Phoenix Bulk Depot, Lanang,
(Revised September 2016) Davao City, Philippines 8000 Page 1 of 4
PHOENIX PETROLEUM PHILIPPINES, INC.
Customer Name : __________________________________________________________________________________________
Preferred Mode of Payment: ☐Over-the-Counter Cash Deposit ☐Check ☐Credit Card
Bank Name : ___________________ Account Name : ______________________________________ Account No : __________________
Payment Guidelines: Acceptable payment for Cash Before Delivery transactions are as follows:
[1] Over the counter cash deposit [2] On - us check deposit - cleared funds [3] Manager's Check - confirmed by Treasury Department
Mode of Delivery : ☐ Pick - Up: _____________________ ☐ Delivered; if delivered, indicate your delivery addresses below.
Delivery Address 1
Address City
Province Country Postal Code
Telephone Mobile
Applicable VAT: ☐ Vatable ☐ VAT Exempt ☐ Zero - Rated
Delivery Address 2
Address City
Province Country Postal Code
Telephone Mobile
Applicable VAT: ☐ Vatable ☐ VAT Exempt ☐ Zero - Rated
Billing or Bill To Address: (if different from the registered business address)
Billing Address
Address City
Province Country Postal Code
Note: Use a separate sheet for additional Delivery Addresses or Ship To(s) and Billing Addresses or Bill To(s).
Average monthly consumption of fuel and lubricants (in liters):
Product Estimated Value (in Php) Volume (in liters)
1.)
2.)
3.)
Note: Use a separate sheet for additional product(s).
Authorized Representative of the company to do the following transaction:
Access Levels Name of Representative Contact Number
1. Product Ordering ( )
2. Account Reconciliation ( )
3. Payment Processing ( )
APPLICATION REQUIREMENTS
For Partnership/Corporate Entity For Sole Proprietorship
1. Certificate of SEC Registration 1. DTI Registration Certificate
2. Business Permit 2. Mayor's Permit
3. Registered Articles of Incorporation (Partnership) including 3. Certificate of Registration (BIR Form 2303)
amendments from SEC. 4. Latest 2 years Audited Financial Statements
4. Registered By-Laws including amendments from SEC 5. Annual Income Tax Return
5. Certificate of Registration (BIR Form 2303) 6. Company Profile (***optional)
6. Latest 2 years Audited Financial Statements
7. Annual Income Tax Return For VAT Exempt and Zero Rated claims, kindly attach necessary
documents for validation (e.g. PEZA Certification)
8. Company Profile (***optional)
Note: Processing of Credit Application (including Check on Delivery or COD) will begin after receipt of Application Requirements.
I hereby certify that all the data and statement in this application form are correct and complete, and are made for the purpose of
applying as franchisee or distributor of Phoenix Petroleum Philippines, Inc. The above information, among others, may be used
for the purpose of our credit evaluation by Phoenix Petroleum Philippines, Inc.
Signature Over Printed Name Signature Over Printed Name
Position / Designation Position / Designation
Phoenix Petroleum Philippines, Inc.
Customer Application Form Main Office: Phoenix Bulk Depot, Lanang,
(Revised September 2016) Davao City, Philippines 8000 Page 2 of 4
PHOENIX PETROLEUM PHILIPPINES, INC.
GRANT OF AUTHORITY
Bank Name Branch Contact Person (Designation) Telephone Number
1 ( )
2 ( )
3 ( )
4 ( )
5 ( )
This authorizes Phoenix Petroleum Philippines, Inc., ("PPPI") to conduct credit investigations;
request bank inquiry, and seek account disclosures from all of our depository / creditor banks
enumerated above whenever circumtances warrant.
I/ We hereby waive the benefit under the Secrecy of Bank Deposits Law (RA 1405) and expressly
authorize PPPI to undertake the necessary credit investigations and pertinent bank inquiries to its
satisfaction in support of this application.
I/We indicate, manifest, and express in a letter our consent, permission and willingness to waive all
our rights and benefit under the RA 1405 in favor of PPPI.
Kindly fill out required information below and return this form to Credit Risk Management Unit , or
any authorized representative, and fax directly to Phoenix Petroleum Philippines, Inc., Phoenix Bulk
Depot, Lanang, Davao City through Fax No. (082) 233 - 0168.
To be filled - out by Bank
A. Deposits (please include Time Deposits or other placements)
Account Type Account No. Date Opened ADB Handling Experience
B. Credit Facilities ( please include Domestic BP facility, if any)
Facility Type Amount O/S Balance Collateral Experience
Respondent Bank:
Respondent Name / Signature:
Designation:
Phone Number: ( )
Date:
Signature Over Printed Name Signature Over Printed Name
Position / Designation Position / Designation
Phoenix Petroleum Philippines, Inc.
Customer Application Form Main Office: Phoenix Bulk Depot, Lanang,
(Revised September 2016) Davao City, Philippines 8000 Page 3 of 4
PHOENIX PETROLEUM PHILIPPINES, INC.
SPECIMEN SIGNATURES OF AUTHORIZED SIGNATORY/IES
Authorized Signatories to Sign Checks
Authority Type: ☐ Any One ☐ Any Two ☐ All
Name:
Signature:
Designation:
Name:
Signature:
Designation:
Authorized Signatories to Sign Purchase Orders
Authority Type: ☐ Any One ☐ Any Two ☐ All
Name:
Signature:
Designation:
Name:
Signature:
Designation:
Authorized Signatories to Sign Credit Card Transaction Slip
Authority Type: ☐ Any One ☐ Any Two ☐ All
Name:
Signature:
Designation:
Name:
Signature:
Designation:
Authorized Signatories to Receive Deliveries
Authority Type: ☐ Any One ☐ Any Two ☐ All
Name:
Signature:
Designation:
Name:
Signature:
Designation:
Name:
Signature:
Designation:
I hereby certify that all information / data as provided herein are true and correct and that the above
signatories were duly authorized by the principal / corporation herein named. I fully understand that
any false information herein provided shall be ground to terminate any privileges, rights, and
benefits granted under this account including the principal agreement or any definitive contracts. I
further attest that I am duly authorized to provide foregoing data for the purpose herein set.
Signature Over Printed Name Signature Over Printed Name
Position / Designation Position / Designation
Subscribed and sworn to this ______ day of ____________________ in _____________________________,
Philippines with the foregoing representative presenting to me his / her competent evidence of
identity which is __________________ and further attests that the foregoing is true and correct.
Doc. No.
Page No.
Book No.
Series of
Phoenix Petroleum Philippines, Inc.
Customer Application Form Main Office: Phoenix Bulk Depot, Lanang,
(Revised September 2016) Davao City, Philippines 8000 Page 4 of 4
