ADMATERIALS TECHNOLOGIES PTE LTD

58 Sungei Kadut Loop

Singapore 729501
Tel: (65) 6362 9066 Fax: (65) 6362 2080
Business Registration No. : 200805959C

CUSTOMER PROFILE / REGISTRATION FORM

ADM/FORM/009

1) CUSTOMER COMPANY NAME: (BILL TO)

For Official Use:

Project Code:
ADDRESS: (BILLING PURPOSE)
Date:
Requested By:
Payment Term:
CONTACT PERSON: (Dr / MR / MRS / MDM / MISS)

TEL NO:

Cash
Credit

FAX NO:

2) PROJECT DESCRIPTION:

3) RESULT DESPATCH:

Collection at Lab by Hand

By Fax/Email:
By Post:

4) CERTIFICATION BY ACCOUNT PAYEE:

I hereby certify that the above information furnished by me is correct and agree to abide by the conditions laid
down in the quotation issued by Admaterials Technologies Pte Ltd

Signature & Date:

Name of Customer Representative:

Customer Company Stamp: