Vendor Registration Form

Individual

Company

Name :

Email :

Phone :

Mobile :

Street :

Website Link :

City :

Zip / Postal Code :

Country

State / Province

Capital Revenue :

Company Size :

Status PKP :

NPWP Perusahaan :

SPPKP & SKT Perusahaan :

Nomor Induk Berusaha (NIB) :

Company Profile :

Legalitas Lain (1) : *opsional (jika ada)

Bank	Account Number