Business Customer Information Form
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1
2New Customer
Customer Records Update (for existing PLDT customers)
BUSINESS CUSTOMER INFORMATION FORM
Date Accomplished/Signed:
/
/
To be filled out by the Customer
BASIC CUSTOMER INFORMATION
Customer/Business Name:
Main Telephone No./Trunkline:
Fax No.:
Customer's Business E-mail Address:
Website:
Business Address:
Block & Lot #
|
Room/Unit/Door/Stall#
|
Floor
|
Building/Apartment
|
Street
Subdivision /Village
|
Barangay
|
City/Town
|
Province
Years in Operation:
Business Ownership:
Private
Government
Services
Travel & Leisure
Wholesale and Retail trade
Manufacturing/Logistics and Distribution
Industry Type :
(Restaurants, hotels, resorts,
(Education, Health Services, Public Service Professional
(Food, apparel, furniture manufacturing)
(Food & Beverage, Fashion & Apparel, Supplies)
Services, Manpower, Outsourcing)
spa, travel agencies)
PARTNERSHIP
CORPORATION
Type of Business (Check only one)
SINGLE PROPRIETORSHIP
Tax Class:
With VAT
VAT Exempt/ Zero-Rated
Others
SEC Registration No.
Company TIN:
AUTHORIZED SIGNATORY INFORMATION
Name of Authorized Signatory:
Position:
Signature:
Contact Nos. (Landline):
Mobile No.:
Email address:
Area Code
|
Telno
ID Presented:
Passport; ID No. ____________________
Company ID; ID No. ________________
PRC ID No. _______________________________
Driver's License; ID No. _____________
SSS/GSIS ID; ID No. ________________
Others ________________ ; ID No. ____________
CONTACT DETAILS FOR BILLING & ACCOUNT RECEIVABLES
Billing Address (if different from Business Address):
Block & Lot #
|
Room/Unit/Door/Stall#
|
Floor
|
Building/Apartment
|
Street
Subdivision /Village
|
Barangay
|
City/Town
|
Province
Name / Designation:
Name / Designation:
Names of Bill Recipients:
1 .
2 .
Mobile:
Mobile:
Landline:
Landline:
Contact numbers of Bill Recipients:
Area Code |
Telno
Area Code |
Telno
Email Address of Bill Recipients:
1 .
2 .
CONTACT DETAILS FOR INSTALLATION
Installation Address (if different from Business Address):
Block & Lot #
|
Room/Unit/Door/Stall#
|
Floor
|
Building/Apartment
|
Street
Subdivision /Village
|
Barangay
|
City/Town
|
Province
Name / Designation:
Name / Designation:
Operations/Technical Contact Person:
Mobile:
Mobile:
1 .
2 .
Landline:
Landline:
Contact Nos. :
Area Code |
Telno
Area Code |
Telno
Email Address:
1 .
2 .
Name / Designation:
Name / Designation:
On-site Contact Person:
Mobile:
1 .
2 .
Landline:
Landline:
Mobile:
Contact Nos. :
Area Code |
Telno
Area Code |
Telno
Email Address:
1 .
2 .
SERVICE REQUEST DETAILS
TYPE OF SERVICE (Proposed service)
QUANTITY
Estimated Monthly Recurring Charge (MRC) - VAT Exclusive
PHP
USD
Total =
Special Instructions:
Preferred Date of Installation:
/
/
I hereby declare that all the above information are true and correct to my own knowledge. I hereby authorize PLDT to verify any of the above given information
from whatever source it may consider appropriate. Any misrepresentation on the above information shall constitute a just cause for the rejection of my application or
the termination of my contract with the Company.
Authorized Signatory/Signature above Printed Name
Position
Date
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Parent category: Business