Government Entity

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Government Entity

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Product Category Priority*

Name*

Mobile Phone*

Billing Address

House No./Unit-Floor/Building Name/Street Name*

Country*

State/Region*

Town/City*

Postal Code*

Preferred Billing Date*

Preferred Billing Time*

Shipping Address

Same as Billing Address

Same as Billing Address

House No./Unit-Floor/Building Name/Street Name*

Country*

State/Region*

Town/City*

Postal Code*

Payment Options*

VAT REG*

VAT Zero-Rate Certification, Certificate of Registration by IPA/PEZA & sworn affidavit executed by the REE*

Other please specify*

Billing Requirements*

Billing Requirements Info*

DTI/SEC & GIS

BIR 2303

License to Operate (FDA/DOH)

Finance Contact Person Name*

Finance Contact Person Designation*

Finance Contact Person Number*

Finance Contact PersonEmail Address*

Email Address*

Username*

Password*

Confirm Password*

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