Dealership Form

*

Products	Brands	Manufactured At

Name of Partners (if Partnership) or Name of Incorporators (if Incorporation)*

Full Name	Position	Address

Affiliated Company / Branches / Other Offices*

Brand / Affiliate	Address	Telephone No.

Present Suppliers*

Company	Address	Telephone No.	Industry	Products Purchased

Bank References*

Bank	Branch	Contact Numbers

Accounting
Primary Accounting Person*
First Last
Position*
Email*
Mobile Number*
Telephone Number*
Fax Number
With Alternate Accounting Person*
- Yes
- No
Alternate Accounting Person*
First Last
Position*
Email*
Mobile Number*
Telephone Number*
Fax Number
Technical
Primary Technical Person*
First Last
Position*
Email*
Mobile Number*
Telephone Number*
Fax Number
With Alternate Technical Person*
- Yes
- No
Alternate Technical Person
First Last
Position*
Email*
Mobile Number*
Telephone Number*
Fax Number
Other Requirements*
1. Company Profile 2. SEC /DTI Registration 3. Articles of Incorporation 4. BIR Registration 5. Business Permit 6. Organizational Chart 7. Signature Specimens of all Authorized Personnel

Bank Information Request
Please fill-up so we may submit information from your bank.
Dealer / Company Name*
Contact Person*
First Last
Address*
Street Address Address Line 2 City ZIP / Postal Code
Bank Information
Bank Name*
Address*
Street Address Address Line 2 City ZIP / Postal Code
Contact Person*
First Last
Telephone Number*
Account Name*
Account Number*

Signatories*

No. of years banking there*
Authorized*
- I authorize MySolutions to inquire about my credit standing with the above name bank.
Authorized by*
First Last
Designation / Job Title
Department*
Date*
CAPTCHA
Certify*
- I herby certify that all information given is true and correct, and agree to notify MySolutions, of any changes thereon. I authorized MySolutions Inc. to investigate all information and references contained in this profile sheet.

Company Profile