FORMULIR PERMOHONAN KREDIT

CREDIT APPLICATION FORM

Tanggal ( Date ) : __________________________________________________

No. : __________________________________________________

I. DATA PERUSAHAAN ( COMPANY PROFILE )

Nama Perusahaan : PT PRISMA KREASI ARTHISTA

( Company Name )
Alamat Perusahaan : Graha Elok Mas 83A/1 Jl Raya Panjang, Duri Kepa,Jakarta Barat
( Address )
Phone / Fax : 021-5647819

NPWP (Tax Number) : 01.622.727.4-039.000

Susunan Pengurus ( Board Of Management ) Pemegang Saham ( Shareholders )

1.
2.
3.
4.
5.
6.
Bagian Pembelian yang Dihubungi : _______________________________________
( Contact For Purchaser )
Bagian Keuangan yang Dihubungi : _______________________________________
( Contact For Accounts )

II. RENCANA KEBUTUHAN BETON ( CONCRETE ORDER PLANNING )

Total Kubikasi ( Total Volume ) : 1200 m3

Jangka Waktu Proyek ( Project Period ) : 8 Bulan
III. PROSEDUR PEMBAYARAN ( PAYMENT PROCEDURE )

Jangka Waktu Pembayaran : _________________________hari/days

( Credit Terms )

Batas Jumlah Kredit yang disetujui : Rp._____________________________

( Credit Limit )

Jenis & Nilai Jaminan : ________________________________

( Type & Value of Guarantee )

Bank Garansi (Bank Guarantee) : S/Rp. ___________________________

L/C Lokal ( Letter of Credit L/C ) : Rp._____________________________

Uang Muka ( Down Payment ) : Rp._____________________________

IV. DOKUMEN YANG DILAMPIRKAN (SUPPORTING DOCUMENT)

Dokumen yang Dilampirkan (Supporting Document) Available N/A

1. Akte Pendirian Perusahaan dan Perubahannya (Article Associate)

2. NPWP / PKP ( Govermment Tax Number )

3. SIUP / IUT / SIUJK ( Company’s Operational License )

4. Fotokopi KTP Direktur Perusahaan ( Copy Of Company

Director’s ID Card )
5. Ijin-Ijin / Surat Keterangan Lainnya ( Other License )/ Rekening
Koran 3 Bulan Terakhir

Saya menyatakan bahwa informasi diatas adalah benar ( I/ We State The Truth Of The Above
Information )

Pemohon (Applicant ) Checked by: Approved by:

_________________ ___________ __________ ____________

Director Of Company Sales Person Credit Dept. Credit Committee
& Company Stamp