Credit Application Form

<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Credit Application Form

CREDIT APPLICATION FACILITY

Use the 'Tab' key to work your way through this Credit Application Form.

Trading name of business	Registered name of business
Previous trading/registered names	Incorporated form of business
Reg. number of incorporation	VAT registration number
Date of establishment of business (dd-mmm-yyyy)	Registered name of holding company
Names of subsidiary and associate companies	Business activities
Physical address	Postal address



	Code
Are invoices sent to your postal address? If not, then where?	Email address
Registered address	Telephone area code and number
	Facsimile area code and number
	Premises owned or leased
	Name of landlord
Code	Postal address of landlord






Details of Proprietors, Directors, Members, Partners


Full name	I.D. Number
Residential address (use a comma to separate lines)	% Shareholding / Interest



Full name	I.D. Number
Residential address (use a comma to separate lines)	% Shareholding / Interest



Full name	I.D. Number
Residential address (use a comma to separate lines)	% Shareholding / Interest



How long has the Proprietor(s) owned the business
Auditors/Financial officer's name	Telephone area code and number


Banking details


Institution	Branch
Date opened (dd-mmm-yyyy)	Account name
Account number


Trade references


1.
Name	Telephone area code and number
Address (use a comma to separate lines)	Credit limit
Notes:



2.
Name	Telephone area code and number
Address (use a comma to separate lines)	Credit limit
Notes:



3.
Name	Telephone area code and number
Address (use a comma to separate lines)	Credit limit
Notes:



4.
Name	Telephone area code and number
Address (use a comma to separate lines)	Credit limit
Notes:



List all sureties, cessation of debtors, notarial bonds, judgements
List liquidations, sequestration's against the business or its principals
Have moratoriums or offers of compromise ever been made to any creditors?		Yes No
Can the latest audited Financial Statements be made available?		Yes No
If yes, what year?	Surety offered to substantiate credit limit
Account contact person	Order numbers used?
Credit requested



By clicking the "Submit" button you indicate that you accept the Standard Conditions of Agreement. You acknowledge that any amount due for services will be due unconditional 30 days from date of statement issued by Speedy Overborder Services (Pty) Ltd. You hereby bind yourself as co-principal debtor jointly and severably. You hereby declare that no cheques will be issued in payment unless there are sufficient funds available and that such funds will remain available in order that all cheque payments will be honoured and that under no circumstances will any cheque be stopped.