CUSTOMER EVALUATION QUESTIONNAIRE

                                          Bill To                                                   Ship To
Customer Name Consignee Name
Address Address
Address1 Address 1
City City
State State
Zipcode Zipcode
Country Country
Phone Phone
E-Mail E-Mail
    Contact Person
                                                                                                           Notification
Contact Person Zipcode
Address Country
City Phone
State E-Mail
                                                                                                      Business Information
Owner/Officer Business Phone
Business - EMail Business Fax
Purchasing Manager Purchasing Phone
A/p Manager A/P Phone
                                                                                                      Discounts / Commission
Commission % if any to Customer Rebate % discount if any
    Any discount at our end - No claim discount
    Is any Rebate deductible
                                                                                                        Logistic Information
Forwarder Name Zipcode
Address Country
City Phone
State E-Mail
                                                                                                            Testing / Quality
                          Testing Requirement                                  Testing Labs and Charges
Testing standards/Manual if any Nominated/Preferred
    Testing Lab Name
    Testing charges to be added in the price or to be invoiced separately?
                                                                                                   Commercialization Sequence
                         Requirement Timeline                                           Sign off / Courier Information
Fit Will samples be signed off and sent to us [Yes/No]  
Wear
Confirmation Samples  
Size & SKU Courier Name
No of Pairs Courier Account No
                                                                                                 Social & Environment Compliance
Provide your Social & Environmental Code of Conduct
Are you Member of BSCI , ETI etc?
                                                                                                      Business Credit Information
Please Circle One:      
Type of Business    
Tax Exempt # State Org. ID# (if any)
Dun & Bradstreet ID# How Long In Business
    Web site details
Bank Name Bank Acct. #
Address Bank Contact
City Bank Phone
State Bank Fax
Zipcode Bank Swift Code
       
                                                                                                                Terms Of Sales
Accounts are payable according to the terms listed on the invoice or as otherwise established by written agreement. A finance charge of 1.5% per month (18% per year) or applicable statutory limit, will be charged on unpaid balance of past due accounts. In the event of default, the undersigned agrees to pay all costs of collection including a reasonable attorney's fee and court costs. Should credit availability be granted by ECGC India Ltd., all decisions with respect to the extension or continuation shall be the sole discretion of ECGC India Ltd. and may be terminated within its sole discretion. The undersigned states that they are the legally binding purchaser and understands all of the terms and conditions herein.
Date :