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PT. SRIREJEKI PUTRI MANDRI- SUPPLIER REGISTRATION CONFIRMATON
Please fill in this form to complete your registration as Raja Fresh - SUPERMARKET Bussiness Partner.
Account information
Username:
*
Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.
E-mail address:
*
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Company Details
Supplier:
*
Select
PT
CV
Others
Company Name:
*
Purchase Method:
*
Select
Direct Purchase
Consingment
Supplier ID:
(Filled By RajaFresh)
Status:
*
Select
PKP
Non-PKP
NPWP:
*
Bank Details
Bank Name:
*
Branch:
*
Beneficiary Name:
*
Account Number:
*
SUPPLIER - ADDRESS
Head Office Address
Address:
*
Phone:
*
Fax:
*
City:
*
Post Code:
*
Representative Office Address
Address:
*
(Building, Street, Province, Telp, Fax)
Phone:
*
Fax:
*
City:
*
Post Code:
*
SUPPLIER - CONTACT PERSON
Owner
Name:
*
Mobile Contact:
*
E-mail Address:
*
Marketing/Sales Manager
Name:
*
Mobile Contact:
*
E-mail Address:
*
Merchandise/Brand Manager
Name:
*
Mobile Contact:
*
E-mail Address:
*
Trade Promotion Manager
Name:
*
Mobile Contact:
*
E-mail Address:
*
Finance & Accounting Manager
Name:
*
Mobile Contact:
*
E-mail Address:
*
PRINCIPAL CONTACT
Address:
*
(Building, Street, Province, Telp, Tax)
Phone:
*
Fax:
*
City:
*
Post Code:
*
Person in charge
Name:
*
Mobile:
*
E-mail Address:
*
Charged To
Charged To:
*
Select
Principal
Distributor
Returnable Goods
Returnable Goods:
*
Select
Yes
No
Principal Contact
