PLANILLA IOMA - ALTA ENTES 72hS

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ALTA ENTES 72 HS. FECHA. NOMBRE Y APELLIDO COMPLETO. CU IT: NUMERO DE CUENTA. TIPO DE CUENTA: SUCURSAL: CBU: TRAMITE DE REFERENCIA: PERSONA FISICA O JURIDICA:

DIRECCION: TELEFONO/S: MAIL:

Marcar con lx) lo que corresponda. CARGA ENTE: CARGA CUENTA: En caso de tener OP. Nro. OP:

OTROS DATOS:

OBSERVACIONES: