GRATEFUL MIND ENTERPRISE

Blk 4 Lot 10 Ph3 St. Gabriel Heights Antipolo

Telephone # -219-9369 / 0917-5452031 Email:
gratefulmindenterprise@gmail.com

CLIENT INFORMATION FORM

DATE OF APLLICATION: ______________________

REGISTERED COMPANY/BUSINESS NAME: ___________________________________________

COMPLETE BUSINESS ADDRESS:

( ) OWNED ( ) PROVIDED FREE ( ) RENTED SINCE ( ) LENGTH OF STAY _______

TELEPHONE NUMBER: ___________________ ( ) PREPAID ( ) POST PAID

FAX NUMBER: __________________________ ( ) PREPAID ( ) POST PAID

PROVINCIAL HOME ADDRESS: CONTACT PERSON:

_____________________________________________ ______________________________

______________________________________________________________________________

TYPE OF BUSINESS:

( ) SINGLE PROPRIETOR ( ) PARTNERSHIP ( ) CORPORATION

IF SINGLE PROPRIETOR:

NAME OF OWNER _________________________________ SIGNATURE: ___________________

IF PARTNERSHIP OR CORPORATION PLEASE COMPLETE THE FOLLOWING:

PRINCIPAL STOCK HOLDER POSITION/TITLE SIGNATURE

_____________________ __________________ ________________________

_____________________ __________________ ________________________

_____________________ __________________ ________________________

_____________________ ___________________ ________________________

PERSONS AUTHORIZED TO PURCHASE AND RECEIVED GOODS:

NAME POSITION SPECIMEN SIGNATURE

_____________________ __________________ ________________________

_____________________ __________________ ________________________

_____________________ __________________ ________________________

BANK REFERENCES: ( ) CURRENT ( ) SAVINGS

NAME OF BANK BRANCH ACCOUNT NUMBER

_____________________ __________________ ________________________

_____________________ __________________ ________________________

_____________________ __________________ ________________________

OTHER TRADE/SUPPLIER REFERENCES:

COMPANY NAME EXISTING CREDIT LIMIT TELEPHONE #/CONTACTPERSON

_____________________ __________________ _____________________________

_____________________ __________________ _____________________________

_____________________ __________________ _____________________________

OTHER TRADE/CUSTOMER REFERENCES:

COMPANY NAME EXISTING CREDIT LIMIT TELEPHONE #/CONTACT PERSON

_____________________ __________________ _____________________________

_____________________ __________________ _____________________________

_____________________ __________________ _____________________________

 FOR GRATEFUL MIND ENTERPRISE USE ONLY
CREDIT DECISION APPROVED DIS-APPROVED RECONSIDERED (Sign over Printed
CHARACTER Name)

CAPACITY Investigated
By: ____________
CAPITAL
C&C
RES./CONDITIONS
Date: __________
FINDINGS:_____________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

Check appropriate boxes and indicate below the reasons for approval,
disapproval, or reconsideration of disapproved application. No delivery
shall be made unless the application has been approved and signed and the
required documents submitted.
Reviewed by:
Reasons: ______________________________________________________ _________________
______________________________________________________________ CO Date______
______________________________________________________________
______________________________________________________________
CREDIT LIMIT APPLIED FOR: _____________________ CREDIT TERMS: ____________________

I hereby certify that information stated here is true and correct. I hereby agree that all our
purchases on credit shall be subject to the terms and conditions stipulated in your invoices. I
also hereby authorize your company to do necessary credit investigation on my behalf. If any
misinformation occurs during the investigation and background checking, your company has
the right to cancel my application for credit term.

__________________________________
Signature over Printed Name/Date
REQUIREMENTS TO BE SUBMITTED:

1. ATLEAST 5 YEARS ESTABLISH COMPANY WITH 5 YEARS BANK ACCOUNT.

2. COMPLETION OF APPLICATION FORM, DULY SIGNED BY PRESIDENT OR OWNER OF THE
COMPANY OR GENERAL MANAGER.
3. PHOTOCOPIES OF THE FOLLOWING:
A.)MAYOR’S BUSINESS PERMITS
B.) DTI OR SEC REGISTRATION.
C.) UPDATED CERTIFICATION OF REGISTRATION (2303).
E. UPDATED PAYMENT FORM (0605)

4. UPDATED GENERAL INFORMATION SHEET STAMPED BY SEC.

5. UPDATED AUDITED FINANCIAL STATEMENT STAMPED BY BIR.
6. 3 VALID ID’S OF THE OWNER AND MAJOR STOCKHOLDERS OF THE
COMPANY/SIGNATORIES.
7. 2X2 PICTURE OF THE OWNER AND MAJOR STOCKHOLDERS OF THE
COMPANY/SIGNATORIES.
8. PHOTOCOPY OF ATLEAST 1 PROOF OF BILLINGS OF THE COMPANY OR OWNER.