Buyer Organization Registration Form

Note: Asterisk (*) indicates mandatory fields

ORGANIZATION INFORMATION:

Organization Name * : _____________________________________________________________________________

Acronym : _____________________________________________________________________________

Former Name : _____________________________________________________________________________

Government Branch* : Constitutional Office Executive Judiciary Legislative Local Govt. unit
Non- Benefit Organization Non-Government Organization

Organization Type* : Attached Agency City Government Department Department & Consular Mission
Elementary GOCC High School Hospital Municipal Governments SUC
Provincial Government Barangay Bureau others

Sector* : Agriculture Agrarian Reform and Natural Resources Domestic Security Health
Education, Culture and Manpower Development Housing and Community Development
Social Security, Welfare and Employment Subsidy to Local Government Units
Communications, Roads and other Transportation Public Order and Safety Tourism
Economic Services General Administration General Public Services
Peace and Order Water Resources Development and Flood Control Power &Energy
Trade and Industry Social Services Undefined

Agency Tax Identification Number*: - - -

Website Address* : ________________________________________________________________________________

Brief Description of the Organization :___________________________________________________________________

ORGANIZATION ADDRESS:

Region* : ________________________________________________________________________________

Province* : ________________________________________________________________________________

City/Municipality* : ________________________________________________________________________________

Street Address :_________________________________________________________ Zip Code:_______________

CONTACT INFORMATION:

Salutation Titlle : Mr. Ms.

First Name* : _________________ Middle Name : ______________ Last Name *: _______________________

Designation* : ________________________________________________________________________________

Phone No.* : ______ - ______ - ______ Loc.: ________ (e.g. 632-999-9999 Loc. 133)

Fax No. : ______ - ______ - ______ (e.g. 632-999-9999)

Email Address * : ______________________________ (e.g. buyer@philgeps.net)

_______________________
SIGNATURE

Cristobal Street, 1007 Paco, Metro Manila, Philippines Tel. Nos. 561-7027/Fax563-9395
GEPS- Unit 2504, The Raflles Bldg.,F. Ortigas,Jr. road, Ortigas Centre, Pasig City 900-5234/Fax900-5239