8 Kykoedie Street, Nelspruit,1200, P.O.Box 1588, Barberton,1300

Tel/Fax: (013)752 4525/2172/8242/2182/7551480 – Fax: 0865 144 857

Cell: 082 575 9924 – 082 332 9787 – Email: snf@polka.co.za

Vat No.: 4900211980

Credit Application Form

Registered Name of applicant: 

Trading Name(if Applicable):

Nature of Business:

Postal Address:

 

                                                                                                                              Code:

Physical Address:

                                                                                                                               Code:

Company Registration no.:

Vat Registration no.:

NAMES OF DIRECTORS/MEMBERS/PARTNERS OF THE SOLE PROPRITOR

Full Names & Surnames

I.D Numbers

Residential Address

Property

Owned

Contact No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone no.:                               Fax:                                  Cell:                         email:

Auditor/ Accounting officers Name:                                                  Contact No.:

Kindly Attach a copy of your latest management or audited financial statement

Monthly Credit Required:

Details of premises(rented or Owned)

If not owned please state details of owner and contact no.:

 

Associated Company (if any):

TRADE REFERENCES – FOUR MAJOR TRADE CREDITOR

Company Name

Telephone no.

Contact person

Credit limit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bankers:                                                          Branch:                         Account No.:

Overdraft Facility: R                                                     Overdraft amount in use: R

 

Please attach your cc document and ID copies

 

Any additional information to support your application(ie copies of orders on hand or tenders)

Date: ____________________                  Name: ________________________

 

Signature:_______________________       Witness: ________________________   

Your Satisfaction is our Pleasure