ICPO

IRREVOCABLE CORPORATE PURCHASE ORDER FORM

Referral / Agent's Name / Customer Code

THE UNDERSIGNED BUYER HEREBY STATES AND CONFIRMS IRREVOCABLY, WITH FULL LEGAL AND CORPORATE RESPONSIBILITY AND UNDER PENALTY OF PERJURY THAT WE ARE READY TO PURCHASE EURO 4 DIESEL WITH THE SPECIFICATIONS LISTED BELOW. THE UNDERSIGNED ALSO HEREBY AGREES TO THE TERMS AND CONDITIONS OF THIS ORDER. *

YES, I AGREE

DESCRIPTION*

EURO 4 DIESEL

QUANTITY*

MODE OF PAYMENT*

DIRECT BANK DEPOSIT / TRANSFER

BANK GUARANTEE

DATE OF DRAW*

PLEASE SPECIFY IF OTHER AREAS IS SELECTED

COMPANY NAME*

COMPANY REGISTRATION NUMBER

COMPANY ADDRESS*

COMPANY CONTACT/FAX NUMBER*

COMPANY E-MAIL ADDRESS*

YOUR COMPANY'S AUTHORIZED REPRESENTATIVE / SIGNATORY*

DESIGNATION OF THE AUTHORIZED REPRESENTATIVE*

BUYERS BANK *

BRANCH OF ACCOUNT*

BANK TELEPHONE NUMBER*

BANK TELEX / SWIFT CODE

BANK OFFICER'S NAME AND DESIGNATION*

BANK OFFICER'S DIRECT TEL. NO.*

BANK OFFICER'S EMAIL ADDRESS*

BANK ACCOUNT NAME*

BUYERS BANK ACCOUNT NUMBER*

WITH THIS ICPO, THE UNDERSIGNED CONFIRMS THAT THE FUNDS ARE AVAILABLE FOR THE PURCHASE DESCRIBED AND WE HEREBY AUTHORIZE THE DESIGNATED SELLER TO PERFORM A VERIFICATION OF FUNDS IN OUR BANK ACCOUNT TO VALIDATE SOLVENCY IN RELATION TO THE GIVEN TRANSACTION*

YES, I AGREE

THE UNDERSIGNED HEREBY STATES AND CONFIRMS THAT ALL INFORMATION PROVIDED HEREIN ARE CORRECT AND THAT HE SHALL BE BOUND TO THE OBLIGATIONS ARISING THEREIN SUBJECT TO THE RULES ON ELECTRONIC EVIDENCE AND THE RULES OF COURT.*

YES, I AGREE

BY SUBMITTING THIS ICPO FORM, THE UNDERSIGNED GRANTS FREE, VOLUNTARY, AND UNCONDITIONAL CONSENT TO THE COLLECTION AND PROCESSING OF ALL PERSONAL DATA, AND ACCOUNT OR TRANSACTION INFORMATION OR RECORDS RELATING TO THIS TRANSACTION AS DISCLOSED TO THE INFORMATION DATABASE SYSTEM OF INNOMINDS AND/OR ANY OF ITS AUTHORIZED AGENT/S OR REPRESENTATIVE/S AS INFORMATION CONTROLLER IN ACCORDANCE WITH REPUBLIC ACT (R.A.) 10173, OTHERWISE KNOWN AS THE “DATA PRIVACY ACT OF 2012” OF THE REPUBLIC OF THE PHILIPPINES, INCLUDING ITS IMPLEMENTING RULES AND REGULATIONS (IRR) AS WELL AS ALL OTHER GUIDELINES AND ISSUANCES BY THE NATIONAL PRIVACY COMMISSION (NPC).*

YES, I AGREE

SIGNATURE*

FULL NAME*

DATE SUBMITTED

Please fill out the form below and provide the necessary details then click submit. We will then process your order, expect feedback from us within 48 hours from the time this form is submitted. This ICPO form shall not serve as a final Sales Contract pending confirmation from the subject Depot.

IRREVOCABLE CORPORATE PURCHASE ORDER FORM

Please fill out the form below and provide the necessary details then click submit. We will then process your order, expect feedback from us within 48 hours from the time this form is submitted. This ICPO form shall not serve as a final Sales Contract pending confirmation from the subject Depot.

Items indicated by an Asterisk (*) are mandatory entries.

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