AST Bearings

New Customer Information Form

============================
Routing:
Submitted by: Reginaldo Isidoro Ribeiro Date: 08/03/2017 Accounting
Customer #: Marketing

Billing Address Shipping Address (if different) Ship Via:

Account No
Company Name: SYSTRON Reginaldo Isidoro Ribeiro

Street Address: R. Francisco Acquarone 70 apt501 bl02 2220 Meridian Blvd Suite #07460

City, State and Zip: Rio de Janeiro, Rio de Janeiro, 22755-170 Minden, NV, 89423, USA

Telephone: 55-21-999784557
Resale #
Fax: xxxx
Distributor: OEM:
Email: izidorpi@gmail.com
Duns#:
Contact: Reginaldo Isidoro Ribeiro
For Accounting Dept:

Bank (1) and Trade References (3): attach separate sheet

D & B Information:

Assigned Salesman: How did Customer Hear of AST Bearings?

Design News Design World E-mail Campaign
Type of Business: Credit Limit:
LinkedIn NASA Tech Briefs New Equipment Digest
Market Segment:
Other Referral Sales Call/RSM Approved By: Date:
SIC Code:
2014 IFPE Web Ad (PPC) Web Search Notes:
Order Pending?yes If yes, $ amount:us$50.40

FORM NO. CSF-04-0201 REV. C

DATE REVISED: 03/24/2014 DCR14-035