BBBEE STATUS = LEVEL 1

13 Blossom Street, Silvertown, Athlone, 7764

Tel:021 6372685/2 Fax: 021 633 6828

Email: /

APPLICATION FOR A CREDIT FACILITY

Please attach copies of the following documents:

Company reg.

Members / Directors ID

Cancelled cheque

VAT reg.

Please initial every page in the blocks provided.

REGISTERED NAME OF “THE APPLICANT”
TRADING NAME OF “THE APPLICANT”
PHYSICAL ADDRESS
POSTAL ADDRESS
TELEPHONE NUMBER/S
FAX NUMBER
COMPANY REGISTRATION NUMBER
VAT REGISTRATION NUMBER
DATE ESTABLISHED
TYPE OF BUSINESS (CC, PTY LTD etc.)
HOLDING COMPANY (Should the subject be a subsidiary of any other concern)

Version 3 March2017 Compiled by CP Bestha

Page 2

FULL NAMES AND PARTICULARS

(Directors / Owners / Members / Partners)

1.

NAME
ADDRESS
ID NUMBER
TELEPHONE / CELL PHONE NUMBERS

2.

NAME
ADDRESS
ID NUMBER
TELEPHONE / CELL PHONE NUMBERS

3.

NAME
ADDRESS
ID NUMBER
TELEPHONE / CELL PHONE NUMBERS

4.

NAME
ADDRESS
ID NUMBER
TELEPHONE / CELL PHONE NUMBERS
NATURE OF BUSINESS
BANK INSTITUTE
BRANCH NAME AND CODE
ACCOUNT NUMBER

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Page3

PERSON RESPONSIBLE FOR ACCOUNT
NAME
TELEPHONE NUMBER
EMAIL ADDRESS

TRADE REFERENCES

COMPANY NAME / CONTACT PERSON / TELEPHONE NUMBER / AVERAGE MONTHLY PURCHASES

CONDITIONS OF SALE

The customer acknowledges that should any amount not be paid on the due date, that the entire outstanding balance should immediately become due and payable.

In the event of the Company instructing its attorney / collecting Agent to collect overdue amounts, all legal fees and collection charges shall be for the customer’s account.

Credit facilities may be suspended on any overdue amount and may be re-instated after settlement in full.

Goods may not be returned without our consent. We reserve the right to make a 20% handling charge on goods returned for credit.

All goods are sold on condition that they remain our property until paid for in full.

I/We hereby request that an account be opened in the name of the purchaser and understand that all purchases made will be subject to the conditions of sale as above. I / We renounce the benefits of division and exclussion, revision of accounts, errors in calculation and cession of action, which I / We declare to understand. If any legal action ensuring from my / our indebtedness to the Seller is necessary I / We agree to and accept the jurisdiction of the Magistrate’s Court. I / We accept that I / We shall be responsible for all costs (including attorney and client where applicable) involved in the recovery of any overdue amount owed by me.

PS :Our Terms are strictly 20days from invoice date and is payable by 25th of the month.

If Payment is not received our Computer system automatically puts the Account on Hold.

Please note that a 2.5% Interest above bank rate(10%) on the outstanding amount will be charged to your account if payment was not received in our account by 26 th of the month.

There after the account will be handed over to Debt Collectors and the account would be closed.

Version 3 March2017 Compiled by CP Bestha

I / We have read and understood all the contents of the above and agree to be bound by them.

SIGNED AT ______THIS ____ DAY OF ______20_____

SIGNATURE: 1.______FULL NAME: ______

2. ______

3. ______

WITNESS SIGNATURE______FULL NAME______

WITNESS SIGNATURE______FULL NAME______

Version 3 March2017 Compiled by CP Bestha