OVERSEAS VENDOR REGISTRATION FORM

Vendor Information

Vendor Name (mandatory field)

Please Fill In Required Field

Vendor Country (mandatory field)

Head Office Address (mandatory field)

Please Fill In Required Field

Head Office Phone Number (mandatory field)

Please Fill In Required Field

Indonesian Branch Office Address (If Any)

Indonesian Branch Phone Number (If Any)

Indonesian Local Partner

Please Fill In Required Field

Example Supplied Goods (mandatory field)

Please Fill In Required Field

Contact Information

No	Name (mandatory field)	Phone Number	Position / Job Title (mandatory field)
1.	Please Fill In Required Field		Please Fill In Required Field
2.	Please Fill In Required Field		Please Fill In Required Field

No.	Email (mandatory field minimal 2 email)
1.	Please Fill In Required Field
2.	Please Fill In Required Field
3.	Please Fill In Required Field

Bank Information

Bank Name (mandatory field)

Please Fill in Required Field

Bank Account Name (mandatory field)

Please Fill in Required Field

Bank Account Number (mandatory field)

Please Fill in Required Field

Currency (mandatory field)

Swift Code (mandatory field)

Please Fill in Required Field

Accept Payment with term? (mandatory field)

Please Fill in Required Field

If Yes, Credit Length?

Please Fill in Required Field

Additional Files

No.	Document Name	Expired Date	File Template	Upload File
1.	Bank Statement * *(Max 2MB (.pdf))**			Upload File... Upload

I hereby declare that all information, legality documents, permits, certificates, or other documents attached to this Registration Form are true and and can be accounted for its validity.

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