Credit Application

FULL NAME OF “THE APPLICANT":

TRADE NAME OF "THE APPLICANT":

PHYSICAL ADDRESS:

TEL:

FAX:

Email:

VAT NO:

CO Reg NO:

SOLE OWNER - PARTNERSHIP - (PTY)LTD - CC:

YEAR COMMENCED BUSINESS:

BANKERS:

BRANCH:

ACCOUNT NO:

DATE A/C OPENED:

DETAILS OF DIRECTORS/PARTNERS:

NAME:

ID NO:

TELEPHONE:

TRADE REFERENCE TELEPHONE:

CREDIT LIMIT REQUESTED:

NB: PLEASE NOTE PAYMENT WILL BE 7 DAYS FROM INVOICE

Submitting this form means you have:

SIGNED by THE APPLICANT or its duly authorized agents/signatory who hereby warrants that he/she is
authorized to sign on behalf of THE APPLICANT.