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    Credit Line Application Form Customer Information Sheet

    Uploaded by

    Prince Jade Jocson Andres
    This document is a credit line application form requesting information about a business or individual seeking a line of credit. It requests basic identifying and contact information about the applicant business or owner. It also requests information about the business ownership structure and officers. Additionally, it requests bank and trade references, a list of assets owned, and authorization to conduct a background and credit check on the applicant. The final sections provide for a data privacy consent.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Credit Line Application Form Customer Information Sheet

    Uploaded by

    Prince Jade Jocson Andres
    163 views3 pages
    This document is a credit line application form requesting information about a business or individual seeking a line of credit. It requests basic identifying and contact information about the applicant business or owner. It also requests information about the business ownership structure and officers. Additionally, it requests bank and trade references, a list of assets owned, and authorization to conduct a background and credit check on the applicant. The final sections provide for a data privacy consent.

    Original Title

    CIS Form 1

    Copyright

    © © All Rights Reserved

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    This document is a credit line application form requesting information about a business or individual seeking a line of credit. It requests basic identifying and contact information about the applicant business or owner. It also requests information about the business ownership structure and officers. Additionally, it requests bank and trade references, a list of assets owned, and authorization to conduct a background and credit check on the applicant. The final sections provide for a data privacy consent.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    163 views3 pages

    Credit Line Application Form Customer Information Sheet

    Uploaded by

    Prince Jade Jocson Andres
    This document is a credit line application form requesting information about a business or individual seeking a line of credit. It requests basic identifying and contact information about the applicant business or owner. It also requests information about the business ownership structure and officers. Additionally, it requests bank and trade references, a list of assets owned, and authorization to conduct a background and credit check on the applicant. The final sections provide for a data privacy consent.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    CREDIT LINE APPLICATION FORM

    Customer Information Sheet


    BUSINESS INFORMATION
    Business / In Business
    Company Name Since
    Business Address
    Email
    Contact Number
    Address
    Legal Form Under Please check the appropriate box or indicate your answer if not within the choices
    Which the Business Sole Proprietorship Partnership Corporation
    Operates Cooperative Others ____________________________
    Business Office Owned Rented Php per month
    Name of Parent
    Company, If Subsidiary
    Contact Person Responsible
    Designation
    for Business Transactions
    Landline Nos. Mobile No.
    Accounting Head Mobile No.
    BUSINESS OWNER’S INFORMATION (For Sole Proprietorships Only)
    Complete Name
    Permanent Address
    Home Landline No. Mobile No.
    If Married, No. of
    Civil Status
    Name of Spouse Dependents
    Birthday Citizenship
    Present Address
    CORPORATE / PARTNERSHIP / COOPERATIVE OFFICERS’ INFORMATION
    Officer’s Name 1 Designation
    Home Address 1 Mobile No.
    Officer’s Name 2 Designation
    Home Address 2 Mobile No.
    Officer’s Name 3 Designation
    Home Address 3 Mobile No.
    Officer’s Name 4 Designation
    Home Address 4 Mobile No.
    Officer’s Name 5 Designation
    Home Address 5 Mobile No.
    \

    1|Page of 3
    Customer Information Sheet – Credit Line Application

    PROPERTIES OWNED (Use separate paper if necessary)


    Description / Location Market Value If Mortgaged, To Whom

    Real Estate
    ( Land / Buildings )

    Heavy Equipment

    Share of Stocks
    Other Assets
    BANK REFERENCES
    Bank Name 2
    Branch
    Account Type Account No(s)
    Contact Person
    Contact No.
    Designation
    Bank Name 2
    Branch
    Account Type Account No(s)
    Contact Person
    Contact No.
    Designation
    Bank Name 3
    Branch
    Account Type Account No(s)
    Contact Person
    Contact No.
    Designation
    TRADE REFERENCES
    Supplier’s Name 1
    Contact Person
    Contact No.
    Designation
    Supplier’s Name 2
    Contact Person
    Contact No.
    Designation
    Supplier’s Name 3
    Contact Person
    Contact No.
    Designation

    Information Provided by: Designation: Documents Submitted


    ___ Mayors Permit ___ Financial Stmt. (Audited)
    ___ DTI Reg Cert ___ Valid ID (For Sole Prop)
    Date Signed:
    ___ BIR Reg Cert ___ Others
    Signature Over Printed Name ___ SEC Reg Cert

    2|Page of 3
    Customer Information Sheet – Credit Line Application

    AUTHORITY TO CONDUCT BACKGROUND


    AND CREDIT CHECK

    KNOW ALL MEN BY THESE PRESENTS:

    I (We), the undersigned, do hereby authorize Union Galvasteel


    Corporation, to whom my (our) credit application is submitted, to obtain,
    through its authorized representative/s and accredited third party
    investigators, credit reports that include information about such as but not
    limited to personal data, business profile, records from bank, trade, court,
    assessor’s office and other data as may be deemed necessary in connection
    with the establishment of my (our) credit worthiness.

    IN WITNESS WHEREOF, I have hereunto set my hand this


    _____________________________ in _______________________________.

    …………………………………………….. / …………………………………
    Signature Over Printed Name / Position Tile
    _______________________________________________________________

    DATA PRIVACY CONSENT

    I am (We are) giving my (our) authority and consent to Union Galvasteel


    Corporation and its accredited third party partners to have my (our)
    information collected, stored, shared and processed in accordance with the
    Republic Act 10173 otherwise known as Data Privacy Act of 2012 and other
    laws and regulations.

    …………………………………………….. / …………………………………
    Signature Over Printed Name / Position Tile

    3|Page of 3

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