Dealership Form Step 1 of 6 16% Applying for*Silver DealershipGold DealershipCompany ProfileBusiness Name*Website Telephone Number*Fax NumberAddress* Street Address Address Line 2 City ZIP / Postal Code Year Established*Nature of Business*Products and Services Offered (Please provide attachments if necessary)*ProductsBrandsManufactured At Business InformationType of Business*CorporationPartnershipSole ProprietorshipBusiness License No.*Issued On* Name of Partners (if Partnership) or Name of Incorporators (if Incorporation)*Full NamePositionAddress Affiliated Company / Branches / Other Offices*Brand / AffiliateAddressTelephone No. Present Suppliers*CompanyAddressTelephone No.IndustryProducts Purchased Bank References*BankBranchContact Numbers President / Owner DetailsName* First Last Mobile Number*Telephone Number*Fax NumberEmail* AUTHORIZED PERSONNELSalesPrimary Sales Person* First Last Position*Email* Mobile Number*Telephone Number*Fax NumberWith Alternate Sales Person*YesNoAlternate Sales Person* First Last Position*Email* Mobile Number*Telephone Number*Fax NumberPurchasingPrimary Purchasing Person* First Last Position*Email* Mobile Number*Telephone Number*Fax NumberWith Alternate Purchasing Person*YesNoAlternate Purchasing Person* First Last Position*Email* Mobile Number*Telephone Number*Fax Number* AccountingPrimary Accounting Person* First Last Position*Email* Mobile Number*Telephone Number*Fax NumberWith Alternate Accounting Person*YesNoAlternate Accounting Person* First Last Position*Email* Mobile Number*Telephone Number*Fax NumberTechnicalPrimary Technical Person* First Last Position*Email* Mobile Number*Telephone Number*Fax NumberWith Alternate Technical Person*YesNoAlternate Technical Person First Last Position*Email* Mobile Number*Telephone Number*Fax NumberOther 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 RequestPlease 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 InformationBank 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 TitleDepartment*Date* CAPTCHACertify* 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. This iframe contains the logic required to handle Ajax powered Gravity Forms.
