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ACC Corporate Center Building, E. Rodriguez Jr. Ave.

, Libis,
Quezon City
TEL NOS: 911-0904, 912-73-94 to 97
FAX NOS: 911-7009
Website: www.avls.com.ph

DEALER APPLICATION FORM


Company Name: _____________________________________

Business Address: _________________________________________________________________________________

Telephone Nos.: _____________________________________ Facsimile No.:


_______________________________

Email Address: ______________________________________ Website: ___________________________________

Key Contacts
Information

NAME DEPARTMENT POSITION E-MAIL MOBILE

SALES

SALES

MARKETING

PURCHASING

ACCOUNTING

ADMIN

Company Information

Type of Business: Sole Proprietor Partnership Corporate Others


___________________________

Date Established: __________________________

Parent Company: ______________________________________

Contact Person: ________________________________________ Contact Nos.:


____________________________

Subsidiary: ___________________________________________

Contact Person: ________________________________________ Contact Nos.:


____________________________

Associated Companies: _________________________________

Contact Person: ________________________________________ Contact Nos.:


____________________________
BANK REFERENCE

Bank Name/Branch: _______________________________________________________________________________

Contact Information: ______________________________________________________________________________


(ADDRESS / TELEPHONE / FAX)

SUPPLIERS/ TRADE
REFERENCE

Company Contact Person ADDRESS TEL NO. / FAX E-MAIL


Name NO.

Signed for and on behalf of:

Name of Signatory: _____________________________ Signature: ____________________

Position Held: __________________________________

Please attach the following:


- Company Profile
- DTI / SEC certification

FOR AVLS INTERNAL ONLY

Dealer Requested Approved DATE APPROVED ACCOUNTING SIGNATURE of


Coordinator/ Terms Terms OFFICER ACCOUNTING
A.E.