Step 1 of 8 - 1. Applicant Details

Company

This field is for validation purposes and should be left unchanged.

Name Of Applicant(Required)

First Last

Trading Name (If Applicable)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Applicant Email Address(Required)

Fax Number

Company Registration(Required)

Quoted Company

Public Company

Private Company

Closed Corporation

Partnership

Sole Ownership

Registration Number(Required)

VAT Number(Required)

Date of Registration / Incorporation / Establishment

Customs Code(Required)

Initial(Required)

1. Company Name(Required)

1. Contact Person(Required)

Average Monthly Spend With Supplier(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

2. Company Name(Required)

2. Contact Person(Required)

Average Monthly Spend With Supplier(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

3. Company Name(Required)

4. Contact Person(Required)

Average Monthly Spend With Supplier(Required)

Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please provide details of any Security Previously Given (Cession of Book Debts, Mortgage Bonds, Personal Guarantees, etc.) (Nature of Security, Amount, Beneficiary)(Required)

Name Of Present Clearing Agent(Required)

Are Audited Financial Statements Available?(Required)

Yes

Amount Of Credit Required(Required)

Payment Terms

Initial(Required)

The Company reserves the right, at any time, to discontinue any account and summarily to cancel any credit facilities granted. In the event of these rights being exercised all amounts owing shall immediately become due and payable on demand.
It is acknowledged, that should payments not conform to the terms agreed, interest may be charged on any amount overdue at the maximum rate of interest allowed.
1. The Applicant agrees that should it be in default in meeting its payment terms that the Company shall on its behalf and notwithstanding that the amount of its claim or the nature of the relief sought by it exceeds the jurisdiction of the Magistrates Court, be entitled to institute action out of such Court.
2. Notwithstanding the provisions of 3a) the Company shall be entitled, in its sole discretion, to institute proceedings against the applicant out of the Supreme Court of South Africa (South Gauteng High Court) to whose jurisdiction the Applicant hereby submits.
3. In the event of the Company referring any dispute between it and the Applicant, or any amount due for the collection from the Applicant to it, to its Attorneys the Applicant shall be liable to and hereby indemnifies and the Company against all costs, charges and expenses incurred as between Attorney and his client and such indemnity shall extend to and include collection commission as may be lawfully charged to the Company by its Attorneys.
4. By undersigning this application form, the members/directors are prepared to sign personal guarantees.
The Applicant hereby acknowledges that the Company's Standard Trading Conditions have been specifically brought to their attention and agrees and accepts the terms stated therein and that all business conducted between the Company and the Applicant will be conducted in terms of such Standard Trading Conditions by which he agrees to be bound.
This agreement shall be of full force and effect from the date that any business is transacted between the Applicant and the Company. The signatory hereunder warrants that the information entered on this document is true and correct.

The Company reserves the right, at any time, to discontinue any account and summarily to cancel any credit facilities granted. In the event of these rights being exercised all amounts owing shall immediately become due and payable on demand.
It is acknowledged, that should payments not conform to the terms agreed, interest may be charged on any amount overdue at the maximum rate of interest allowed.
1. The Applicant agrees that should it be in default in meeting its payment terms that the Company shall on its behalf and notwithstanding that the amount of its claim or the nature of the relief sought by it exceeds the jurisdiction of the Magistrates Court, be entitled to institute action out of such Court.
2. Notwithstanding the provisions of 3a) the Company shall be entitled, in its sole discretion, to institute proceedings against the applicant out of the Supreme Court of South Africa (South Gauteng High Court) to whose jurisdiction the Applicant hereby submits.
3. In the event of the Company referring any dispute between it and the Applicant, or any amount due for the collection from the Applicant to it, to its Attorneys the Applicant shall be liable to and hereby indemnifies and the Company against all costs, charges and expenses incurred as between Attorney and his client and such indemnity shall extend to and include collection commission as may be lawfully charged to the Company by its Attorneys.
4. By undersigning this application form, the members/directors are prepared to sign personal guarantees.
The Applicant hereby acknowledges that the Company's Standard Trading Conditions have been specifically brought to their attention and agrees and accepts the terms stated therein and that all business conducted between the Company and the Applicant will be conducted in terms of such Standard Trading Conditions by which he agrees to be bound.
This agreement shall be of full force and effect from the date that any business is transacted between the Applicant and the Company. The signatory hereunder warrants that the information entered on this document is true and correct.

Initial(Required)

Agreement