Page 1 of 4
CUSTOMER INFORMATION
SHEET
GOVERNMENT INSTITUTION INFORMATION
Business / Trade Name LGU BULAKAN
BIR TIN 000 980 508 000
Business Address Camino Real St. San Jose Poblacion, Bulakan Bulacan
Billing Address Pilapil St. San Jose Poblacion, Bulakan Bulacan
Type Local/Provincial Regional National
Classification Hospital Academe Others: Rural Health Unit
Telephone Number 044-760-4275 Fax Number n/a
Email Address rhu2bulakan@[Link] Website n/a
CONTACT INFORMATION
(Please indicate NA if Not Applicable)
Department Name of Department Head Email Address Mobile/Telephone No.
Medical Director Maria Elisa V. Villanueva, M.D. rhu2bulakan@[Link] 09178015923
/President
Purchasing/ Procurement n/a n/a n/a
Accounting/ Finance n/a n/a n/a
Supply/Warehouse/Logistics n/a n/a n/a
Mgt.
REGISTRATION OF AUTHORIZED SIGNATORIES FOR PURCHASE
ORDERS
(This section allow us to validate the authenticity of the P.O sent to us. Please register your Purchasing Personnel, the email
addresses use to send the P.O, or The Fax number use to send the P.O, or other social media account such as Viber
where you may send your P.O.)
Name Email Address Fax No. Others (Viber)
DOCUMENTS REQUIRED TO BE SUBMITTED
1 Copy of BIR Form 2303
2 Latest certificate of VAT Exemption (if
applicable)
3 Latest certificate of Zero-Rated VAT (if
applicable)
TERMS OF REFERENCE
1 All Purchase Orders for MACARE Products (medical devices, laboratory equipment, reagents
and supplies)
must be covered by an APPROVED PURCHASE ORDER duly signed by the authorized signatories
of the customer.
2 Standard 30 Days credit terms is applied to all purchase order unless it is under bidding or
special contract. However, P.O for the Equipment is 50% Downpayment and 50% upon
[Link] payment terms will be applicable on succeeding transactions / [Link].
3 Minimum amount per approved purchase order is PHP 5,000.00. However, this exclude the
purchase order under biddings or special contract.
4 Delivery lead time is seven (7) to ten (10) working days from date of acknowledgement of
MMI-FA-ACP-07_F01 REVISION NO. 01 FEBRUARY 01, 2021
Page 2 of 4
Purchase Order. This is only applicable to NCR, Delivery lead time for other location may varies
based on approved quotation or proforma invoice.
5 Processing of Purchase Order will automatically be held if customer has an outstanding
balance exceeding the approved credit limit or credit terms.
MMI-FA-ACP-07_F01 REVISION NO. 01 FEBRUARY 01, 2021
Page 3 of 4
CUSTOMER CONFORME
This Customer Information sheet will also serve as your Credit Line Application Form and By
signing this form,the undersigned warrants that all information provided are true and correct.
Furthermore, the undersigned is authorized to execute this application and to obligate (NAME OF
CUSTOMER) to pay in full all amount due according to the Sales Invoice(s) on or before the due
date.
By signing this Customer Information Sheet, the undersigned agrees on the Terms of Reference
provided for by MACARE Medicals, Inc.
Name and Signature of Authorized Maria Elisa V. Villanueva, M.D.
Signatory
Designation and Department Municipal Health Officer - Municipal Health Office
Bulakan
Date Signed 12/12/2024
THE SECTION BELOW IS FOR MACARE USE ONLY
Products to be supplied to Hospital
Requested Credit Terms (Days)
Requested Credit Limit (Amount)
Name & Signature of Requesting PAS
Date Requested
Endorsed by
(Name & Signature of Immediate
Superior)
Date Endorsed
ACCOUNTING DEPARTMENT VALIDATION
Signature over Printed Name / Date
Approved Credit Terms (Days)
Approved Credit Limit (Amount)
Date Approved
CREDIT AND COLLECTIONS VALIDATION
Name & Signature of Credit & Collections Officer
Date Approved
PRIVACY CONSENT
By signing this form, You are granting permission to Macare Medicals, Inc. to collect, process and store your
information in line with the Data Privacy Policy Act of the Republic of the Philippines.
Macare Medicals, Inc. collects information to its business partner when they register with us, place an order
for products or services, voluntary complete surveys, and provide feedbacks. The information we may ask
with you may be but not limited to your registered/trade name, TIN, business address, contact number, and
email.
The information you provided to us are being use for the following purposes:
a.) Records the information provided to us in our system to be use for all the transactions such as
processing of orders, collating history of sales and services transactions, processing of service requested,
providing your latest updates in our products and services.
b.) Your provided information are used to submit as statutory requirements to different government
institution such as processing of VAT, Withholding Tax, and other requirements imposed by law.
c.) To establish customer relationship and communicate with you.
d.) Your records provide us a better analysis on how to further improved our services and products offered to
you.
MMI-FA-ACP-07_F01 REVISION NO. 01 FEBRUARY 01, 2021
Page 4 of 4
For full details of our Privacy Policy please see our privacy policy in our website:
[Link]
MMI-FA-ACP-07_F01 REVISION NO. 01 FEBRUARY 01, 2021
