Formulir Distributor

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FORMULIR DISTRIBUTOR NON MODERN MARKET Nama

: ____________________________________________________________

NIK

: ____________________________________________________________

No NPWP

: ____________________________________________________________

Tempat & tgl lahir

: ____________________________________________________________

Alamat Rumah

: ____________________________________________________________

(Sesuai KTP)

____________________________________________________________

Tlp.Rumah (Aktif)

: ____________________________________________________________

HP (Aktif)

: ____________________________________________________________

Pekerjaan

: ____________________________________________________________

Alamat Kantor/Toko

: ____________________________________________________________

Tlp. Kantor/Toko

: ____________________________________________________________

E-mail (Aktif)

: ____________________________________________________________

Nomor Rekening (Aktif) : ____________________________________________________________ Atas nama Rekening

: ____________________________________________________________

Nama Bank

: ____________________________________________________________

Saya yang bertandatangan di bawah ini, menyatakan sanggup untuk bergabung menjadi Distributor dari Ahaa/Kabita dan berkomitmen untuk mematuhi segala peraturan yang berlaku dalam kesepakatan ini. Apabila saya melakukan pelanggaran dalam kesepakatan ini saya siap diproses sesuai peraturan yang berlaku.

............, ....../.............../ 20.... Pemohon MATERAI 6000

( NB: Lampirkan Foto Copy KTP, NPWP, MoU

)

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