New Customer
Customer Records Update (for existing SMART customers)
BUSINESS CUSTOMER INFORMATION FORM
To be filled out by the Customer
Date Accomplished/Signed:
BASIC CUSTOMER INFORMATION
Main Telephone No./Trunkline:
Fax No.:
Customer's E-mail Address:
Website:
Customer Name:
Store/Shop/Outlet Name/Trade Name:
Business Address:
Billing Address (if different from Business Address):
Names of Bill Recipients
1.
2.
Contact numbers of Bill Recipients
1.
2.
Email Address of Bill Recipients
1.
2.
Finance Officer :
Finance Officer Contact Number:
Finance Officer's Email Address:
Business Ownership:
Private
Government
Tax Class:
VAT Exempt/ Zero-Rated
With VAT
SEC Registration No.
Others, please specify
Company TIN:
Industry Type :
Please specify
Name of Authorized Signatory:
Position and E-mail Address:
AUTHORIZED SIGNATORY INFORMATION
Contact No.[Landline No. & Mobile No.]
ID Presented:
Company ID; ID No. ________________
Passport; ID No. ____________________
Driver's License; ID No. _____________
SSS/GSIS ID; ID No. ________________
Others ________________ ; ID No. ___________
ORGANIZATION DATA
Type of Business (Check only one)
Date of Registration:
SINGLE PROPRIETORSHIP
No. of Employee(s)/Staff:
PARTNERSHIP
CORPORATION
Years in Operation:
FOR CORPORATION
Contact No.
Key Officers ( indicate the name and position/designation)
Email Address
FOR PARTNERSHIP - Name of Partners
Name and Position/Designation
Contact No.
Email Address
1.
2.
3.
FOR SOLE PROPRIETORSHIP
Name of Owner :
SSS No.:
Home Address:
FAX No.:
BUSINESS AFFILIATIONS/ORGANIZATIONS:
Personal TIN No.:
Date of Birth:
Telephone No.:
Mobile No.:
Email Address:
ARE THERE ANY PENDING LAWSUITS, FORECLOSURES, BANKRUPTCIES OR OTHER LEGAL ACTIONS OR LITIGATIONS FILED BY OR AGAINST THE COMPANY? [ ] YES [ ] NO If yes, please state cases.
SERVICE REQUEST DETAILS
TYPE OF SERVICE (Proposed service)
QUANTITY
Estimated Monthly Recurring Charge (MRC) - VAT Exclusive
PHP
USD
1.
2.
TOTAL =
I hereby declare that all the above information are true and correct to my own knowledge. I hereby authorize PLDT/SMART/SUN to verify any of the above
given information from whatever source it may consider appropriate. Any misrepresentation on the above information shall constitute a just cause for the rejection
of my application or the termination of my contract with the Company.
Authorized Signatory/Signature above
Printed Name
Position
Date
BCIF_ver5_07292015