Main Office: 714 EDSA, Brgy. E.

Rodriguez, Cubao, Quezon City

Inkwarehouse Enterprise Telefax (02) 4372697 | 09228333572
Website: www.inkwarehouse.ph

Reseller Application Form

PERSONAL DATA
Last Name First Name Middle Name

Home Address: Date of Birth

Telephone No. Mobile No. Email Address:

EMPLOYMENT DATA (IF APPLICABLE)

Employer (Present or most recent) | Business Name (If Self Employed or Business Owner)

Address: Telephone No.

Job Title | Description of your Duties:

Employment Period (Month & Year) Length of Employment (Years & Months) If this application is approved, will you continue to
work for your current job? _____ YES _____NO

BUSINESS INFORMATION
Business Address: Area of Coverage (Province/City):

Will it be placed in an existing business Form of Ownership: _____ Single Prop. Are you interested in opening multiple sites?
establishment? ___ YES ___ NO _____ Partnership ______Corporation ____ YES ____ NO
Business Name:
Will you use any financing aid? ____ YES ____ NO Do you have a Checking Account? ___ YES ____ NO

ACKNOWLEDGEMENTS AND SIGNATURE

A ll t h e i n f o r m a ti o n y o u w ill p r o vi d e in t his f or m w ill b e u s e d t o e s t a blis h a u s er a c c o u n t in f or m a ti o n d a t a b a s e
i n o u r s yst e m . . P e r ti n e n t inf or m a ti o n (e. g. a d d r e s s, t el e p h o n e n u m b e r s) w ill b e u s e d f or a d m i ni str a tiv e
p u r p o s e s, t e c h n i c al s u p p o r t a n d s e c u rit y.

_______________________ _______________________
Applicant's Name and Signature Date

Note: Fax this form at (02) 4372697 or email at inkwarehouse@ymail.com

or bring personally at Inkwarehouse Office: 714 EDSA, Brgy. E. Rodriguez, Cubao, Quezon City