7/24/2019 ADM FORM 009 Customer Registration Form

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ADM/FORM/009

1) CUSTOMER COMPANY NAME: (BILL TO) For Official Use:

Project Code:

ADDRESS: (BILLING PURPOSE)

Date:

Requested By:

Payment Term: Cash

CONTACT PERSON: (Dr / MR / MRS / MDM / MISS) Credit

TEL NO: FAX NO:

2) PROJECT DESCRIPTION:

3) RESULT DESPATCH:

Collection at Lab by Hand

By Fax/Email:

By Post:

4) CERTIFICATION BY ACCOUNT PAYEE:

I hereby certify that the above information furnished by me is correct and agree to abide by the conditions laid

down in the quotation issued by Admaterials Technologies Pte Ltd

Signature & Date: Customer Company Stamp:

Name of Customer Representative:

ADMATERIALS TECHNOLOGIES PTE LTD58 Sungei Kadut Loop

Singapore 729501

Tel: (65) 6362 9066 Fax: (65) 6362 2080

Business Registration No. : 200805959C

CUSTOMER PROFILE / REGISTRATION FORM