Credit Application:

First Name:

 

Trading Name:

 

Postal Address

Address Line 1:

 

Address Line 2:

 

Postal Code:

 

Delivery Address

Address Line 1:

 

Address Line 2:

 

Postal Code:

 

Tel:

 

Fax:

 

Legal Status

Public Company:

 

Private Company:

 

Close Corporation:

 

Partnership:

 

Sole Trader:

 

Company/CC Reg Number:

 

VAT Number:

 

Nature of Business:

 

Date established:

 

In the format DD/MM/YYYY eg. 08/06/1997

Holding Company

Company Name:

 

Address Line 1:

 

Address Line 2:

 

Postal Code:

 

Associated Company

Company Name:

 

Address Line 1:

 

Address Line 2:

 

Postal Code:

 

Name and home address of Directors/Members/Partners/Owner

Full Name:

 

ID Number:

 

Address Line 1:

 

Address Line 2:

 

Postal Code:

 

Banking Details

Bank:

 

Account Number:

 

Branch Name:

 

Branch Code:

 

Credit Limit per Month:

 

Accounts Contact:

 

Trade References

Name:

 

Contact Number:

 

Name:

 

Contact Number:

 

Name:

 

Contact Number:

 

Name:

 

Contact Number:

 

Name:

 

Contact Number:

 

I agree to the Credit Terms below

 

Security Image:

 

Credit Terms:

• OUR CREDIT TERMS ARE STRICTLY 30 DAYS FROM DATE OF STATEMENT.
• OUR MONTH END IS ON THE LAST WORKING DAY OF EACH MONTH AND ALL PURCHASES FOR THE MONTH WILL BE INCLUDED ON OUR STATEMENT.
• OVERDUE ACCOUNTS ARE SUBJECT TO INTEREST AT THE RULING OVERDRAFT RATE.

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