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This vendor application form collects contact and payment information from Universitas Airlangga in Surabaya, Indonesia. It requests the company address, ordering address, payment address, bank details, tax information, purchasing contacts, and finance contacts. The applicant, Alycius Noveno Pieter Riantama, certifies the information provided is true and accurate.
This vendor application form collects contact and payment information from Universitas Airlangga in Surabaya, Indonesia. It requests the company address, ordering address, payment address, bank details, tax information, purchasing contacts, and finance contacts. The applicant, Alycius Noveno Pieter Riantama, certifies the information provided is true and accurate.
This vendor application form collects contact and payment information from Universitas Airlangga in Surabaya, Indonesia. It requests the company address, ordering address, payment address, bank details, tax information, purchasing contacts, and finance contacts. The applicant, Alycius Noveno Pieter Riantama, certifies the information provided is true and accurate.
(Headquarters; No P.O. Boxes) Same as Company Address Same as Company Address
* Name : Universitas Airlangga
Jl. Airlangga No. 4-6, Mulyorejo, Jawa
* Address : Timur 60115, Indonesia * City: Surabaya * State/Country: Indonesia PO Box * Post Code 60115 * Region: Jawa Timur
Communication * Language Bahasa Indonesia * Standard Communication Method: Email (Fax, Email, Post, EDI, or ASN)
Bank Details Tax Information
Bank Name BCA Tax ID: Bank Country Indonesia VAT Registration Number: Bank key ( Sort Code, ABN) If Tax ID not Provided, Reason: Swift Code Bank account Name: Alycius Noveno Pieter Riantama Bank account No: 8161055883 Bank Control Key / Type: Savings (Checking / Savings) IBAN Purchasing Information Finance Details Supplier Contact name (For PO): * Accounts Receivable Contact Name: Alycius Noveno Pieter Riantama Telephone Contact No. * Telephone Contact No. 08970406655 E-mail for Purchase Order * Contact e-mail address: noveno.pieter@gmail.com Fax No.for Purchase Order Contact Fax No. Currency
Zoetis Standard Payment Terms are 60 days
Note: * Fields are mandatory
I certify that the information provided above is true and accurate
Authorized Supplier Signature Print Name Alycius Noveno Pieter Riantama