G/F Ormoc Villa Hotel Bldg., San Pedro St.
, Ormoc City 6541, Leyte
Tel. Nos. (053) 255-3655; 561-7912; 832-0520 • Telefax (053) 561-9344
CUSTOMER’S CREDIT LINE ACCREDITATION
APPLICANT
Name: _______________________________________________________________________________________________
Address: ________________________________________________________________________________________________
________________________________________________________________________________________________
Tel. Nos: _________________________________________Fax No.: _____________________________________________
Mobile Nos: _________________________________________Email Add: __________________________________________
ABOUT YOUR BUSINESS
Registered Business Name : _______________________________________________ TIN: __________________________
Main Office Address : ______________________________________________
( ) Owned ( ) Rented Monthly Rental: ______________ Since When: _________
Telephone Number/s: _____________________________ Fax Number: ______________________
Type of Organization:
___ Single Proprietorship _____ Partnership ____ Corporation
Number of years in the business: __________________ Date started: __________________
Nature of Business: _____________________________________
Customer’s Classification:
____Government _____School/Institution _____Banks ______Hospitals ______ Hotels
____Retail _____ Private Corp _____ SOHO ______ Others
Existing Branches / Other Office Documents to be provided as attachment to this
Address/Telephone Numbers: application if Applicable:
1. _________________________________________ 1. SEC Certificate
2. _________________________________________ 2. BIR Registration
3. _________________________________________ 3. Mayor’s Permit
4. _________________________________________ 4. DTI
5. _________________________________________ 5. Business Permit
Contact Information:
Name Email Address Mobile Number /Direct Line
Manager/President:
____________________ _____________________ ________________________
Purchasing In-charge:
____________________ _____________________ ________________________
Accounting/Payable In-charge:
____________________ _____________________ ________________________
Persons authorized to sign documents and transact with Ormocnet:
Name Position Specimen Signature
1) _________________________________________________________________________________________
2) _________________________________________________________________________________________
3) _________________________________________________________________________________________
Ialodge Bldg. Gaisano Capital T. Oppus St., Abgao,
Bonifacio St., Ormoc City Sogod, So. Leyte Maasin City
(053) 561-7320 (053) 577-8217 (053) 570-8036
G/F Ormoc Villa Hotel Bldg., San Pedro St., Ormoc City 6541, Leyte
Tel. Nos. (053) 255-3655; 561-7912; 832-0520 • Telefax (053) 561-9344
Existing Suppliers with Payment Terms:
Company Name Contact Person Contact # Payment Terms
1.________________ ___________________ ______________________ _____________
2.________________ ___________________ ______________________ _____________
3. _______________ ___________________ ______________________ _____________
4._______________ ___________________ ______________________ _____________
Bank References:
Name of Bank: _______________________________ _________________________________________
Address: ___________________________________ _________________________________________
Telephone Number: ________________________ _________________________________________
Type of Account: ____________________________ _________________________________________
Account Number: ___________________________ _________________________________________
Payment Terms Request:
Credit Limit Request: ________________________ Payment Terms: ___________
AUTHORIZED SIGNATORY <Company’s Head Representative>
I certify that the above information are true, complete & correct. I understand that any
misrepresentation made herein or in any other documents requested by render this accreditation
null & void.
__________________________ __________________
Signature Over Printed Name Date
ORMOCNET USE ONLY
Remarks:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Store Supervisor: Assistant Manager/BDC Supervisor
____________________________ ____________________________
Signature Over Printed Name/Date Signature Over Printed Name/Date
A/R Clerk: Managing Owner:
____________________________ ____________________________
Signature Over Printed Name/Date Signature Over Printed Name/Date
Ialodge Bldg. Gaisano Capital T. Oppus St., Abgao,
Bonifacio St., Ormoc City Sogod, So. Leyte Maasin City
(053) 561-7320 (053) 577-8217 (053) 570-8036
