CUSTOMER REGISTRATION FORM

Terms and Conditions: 

1. By signing below, as part of the credit application process, the customer affirms that the  information provided in this credit application form is true and accurate. The customer  authorizes the company to verify any information provided. 
2. By signing below, I confirm that this clinic will settle payments for the products ordered and delivered within the prescribed payment terms.

It is the responsibility of the customer to ensure that each and every payment has proof  (ex. Screenshot of online transfer, collection receipt from a messenger or Territory  Manager, or marking and signing the Delivery Receipt or Sales Invoice upon payment). 

FOR CASH PAYMENT: 

Collection receipt should be requested/demanded from the Messenger or Territory Manager.  Should there be instances that collection receipt is not available, DMD should ensure that said  payment is recorded in the Delivery Receipt or Sales Invoice in both copies- customer’s and  Trilanz’ copies. 

FOR CHECK PAYMENT: 

All check payments should be issued to TRILANZ DISTRIBUTION INC. as the only PAYEE. 

FOR ONLINE TRANSFER PAYMENT: 

Payments via online transfer using the details below must be supported by a valid proof of deposit  or transfer. The company will consider the payment received only upon verification of the  transaction in the company’s bank statements. 

Bank accounts as follows: 

1. BPI 
2. Name of Account: TRILANZ DISTRIBUTION INC. 
3. Bank Account Number: 4301-0007-96 
4. PNB 
5. Name of Account: TRILANZ DISTRIBUTION INC. 
6. Bank Account Number: 142870005797 
7. GCASH 
8. Name of Account: NO***N N. 
9. Account Number: 0995-476-9700 
10. I hereby agree that any payment/s issued for my orders should be deposited and  transferred to the aforementioned bank accounts only. Any payment/s made not to the official TRILANZ bank accounts would not be honored. To protect both parties, the  customer agrees to validate the accuracy of deliveries and payments via telephone  verification calls initiated by the company. 
11. By signing below, I acknowledge that I have fully read and understood the Credit Application Form (CAF). I understand that if I have any questions or concerns about this  including the Trilanz Payment Terms and Policy, it is my responsibility to discuss these with  my Territory/Account Manager and/or Accounts Receivable Department." (Refer to the  Trilanz Official & Updated Payment Terms). 

For your information and guidance. 

Should you have any question/s, you may contact the Finance Department at 0919-074-2896. Thank you.