A.
(For Company Use Only)
Customer A/C No : ________________________________
CUSTOMER APPLICATION FORM Location : __________________________
Opening New Account Reduce Increase Credit Limit
B. CUSTOMER D. DELIVER TO
Business Name : __________________________________________ Business Name : ____________________________________
Address : __________________________________________ Address : ____________________________________
__________________________________________ ____________________________________
__________________________________________ ____________________________________
Postal Code : __________________________ Postal Code : ____________________
Tel No. : __________________ Fax No. : ___________________ Tel No. : __________________ Fax No. : ______________
Person to Contact : _________________________________________ Person to Contact : ___________________________________
Position : ________________________________________________ Position : __________________________________________
D. BUSINESS REGISTRATION INFORMATION E. TERM OF PAYMENT
Business Reg. No. : __________________ Date : _____________ Proposed Credit Limit : RM ___________________________
(Local No: )
Paid-Up Credit No. Of Days : ____________________
Authorised Capital : _________________ Capital : _____________ Cash
Sole Propietorship Partnership Sdn. Bhd. F. CATEGORY OF CUSTOMER
Name of Propietor / Partners / Directors I/C No. Contractor Departmental Store
1. ________________________________ _____________________
2. ________________________________ _____________________ Developer Sport Centre
3. ________________________________ _____________________
4. ________________________________ _____________________ Hotel / Motel Interior Design
Bankers 1. _______________________ 2. ___________________ Supermarket Others ________________
Branch 1. _______________________ 2. ___________________ ________________
A/C No. 1. _______________________ 2. ___________________ Club House ________________
G. SALES ORDER INFORMATION
Do customer want purchase to be Yes Will Customer Yes Or Yes
confirmed by L.P.O. (Local Purchase Order) accept back order Substitute
No No No
H. CREDIT STANDING WITH OTHER SUPPLIERS
Supplier Name Period Dealing Credit Terms Credit Limit
1. __________________________________ ____________________ ____________________ ____________________
2. __________________________________ ____________________ ____________________ ____________________
3. __________________________________ ____________________ ____________________ ____________________
I/We wish to apply *to open an new account / to reduce / to increase credit limit and Certifies that the above
information given is true and correct.
Authorised signature & chop Date
