1. CUSTOMER INFORMATION SHEET
7th Floor Zen Offices Building, 1111 Natividad Lopez Street, Ermita, Manila, Philippines
T:(02) 789-1000 (Trunkline)
www.fireflyelectric.com
Welcome to FELCO. Please complete the following information to assist in establishing your credit facility with us and in maintaining your Important records and files in
an accurate manner .
Business Name: Year Established:
Business Address:
(No. & Street) (Barangay) (Town) (Province)
Home Address:
(No. & Street) (Barangay) (Town) (Province)
Name of Owner/s: Email Address:
Telephone No./s: Fax No.: Mobile Phone No./s:
Nationality Filipino Filipino-Chinese Chinese Others
T.I.N:
Does your company belong to the Top 20,000 Corporation? (Designated as Withholding Agent) YES NO
TYPE OF BUSINESS
Single Proprietorship Partnership Corporation Cooperative
MAJOR SUPPLIERS
Company Contact No. Company Contact No.
1 6
2 7
3 8
4 9
5 10
BANK REFERENCES
Bank Branch Account No. Account Name
Please note the following company rules and regulations:
Field Sales Personnel (FSP) are NOT allowed:
1. To receive cash payments from clients unless stated in the Delivery Receipt or Invoice.
2. To accept payments from clients during collection unless the FSP issues the necessary FELCO Payment Receipt (PR) to the clients
acknowledging receipt of payment.
3. To withdraw stocks from clients unless proper documentation with signature from FELCO Authorized Representative is presented. Unauthorized
withdrawal of stocks will not be honored by FELCO.
4. To secure personal loans/transactions with any FELCO clients. FELCO shall not be responsible for unpaid personal loans/transactions
entered into by its FSP/s. If you are knowledgeable of any such loans/transactions, please inform FELCO immediately.
AUTHORIZATION:
This is to advise FIREFLY ELECTRIC & LIGHTING CORPORATION that the following person/s is/are authorized to order/purchase/transact business with FELCO, for and in
behalf of the company/sole our account/s with authorized proprietorship/partnership. This also serves as an authorization letter to obtain information on the list of
references given above with authorized representatives.
FULL NAME POSITION SIGNATURE
Authorized
Representatives
Check
Signatories
PERSONAL DATA CONSENT
By signing below, I/we acknowledge that we have been informed of my/our rights by Firefly Electric and Lighting Corporation through their FELCO Data Privacy Policy, as well
as the different aspects of their interpretation of the Data Privacy Act of 2012. As part of our right as stated in the FELCO Data Privacy Policy, I/we am/are agreeing and
consent to the fact that Firefly Electric and Lighting Corporation (FELCO) may collect, use, disclose, process, and store my/our personal information set out in this form
and/or otherwise provided by me/us or possessed by FELCO. Information regarding third parties are stated herein with consent from the said party(ies) to be collected, used,
disclosed, processed, and stored. I/we am/are aware the the information that may be collected, used, disclosed, processed, and stored will be utilized for optimization
purposes of future business with the aforementioned company.
Name & Signature of Proprietor/President
DOCUMENTARY REQUIREMENTS TERRITORY
TO BE FILLED UP BY FSP
DTI Firefly/Led:
Outlet Pictures Royu/Wires: RSM:
I.D Schneider/Chint: SDO:
BIR 2303 Industry: Terms:
Business Permit Region: Proposed Credit Limit:
Purchase Order (P.O) TO BE FILLED UP BY CREDIT PERSONNEL
DISCOUNT
FOR CORPORATION Credit Limit:
SEC Terms: Firefly/Royu:
Article of Incorporation Discount: Led:
General Information Sheet Date: Schneider/Chint:
Financial Statement Approved by: Customer Code: Date: Approved by:
R-F-016 rev. 04
