| Trading name of business |
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Registered name of business |
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| Previous trading/registered names |
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Incorporated form of business |
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| Reg. number of incorporation |
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VAT registration number |
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| Date of establishment of business (dd-mmm-yyyy) |
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Registered name of holding company |
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| Names of subsidiary and associate companies |
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Business activities |
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| Physical address |
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Postal address |
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Code |
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| Are invoices sent to your postal address? If not, then where? |
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Email address |
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| Registered address |
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Telephone area code and number |
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Facsimile area code and number |
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Premises owned or leased |
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Name of landlord |
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| Code |
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Postal address of landlord |
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| Full name |
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I.D. Number |
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| Residential address |
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% Shareholding / Interest |
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| Full name |
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I.D. Number |
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| Residential address |
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% Shareholding / Interest |
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| Full name |
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I.D. Number |
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| Residential address |
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% Shareholding / Interest |
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How long has the Proprietor(s) owned the business |
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| Auditors/Financial officer's name |
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Telephone area code and number |
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| Institution |
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Branch |
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| Date opened (dd-mmm-yyyy) |
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Account name |
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| Account number |
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| Name |
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Telephone area code and number |
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| Address |
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Credit limit |
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| Notes: |
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| Name |
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Telephone area code and number |
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| Address |
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Credit limit |
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| Notes: |
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| Name |
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Telephone area code and number |
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| Address |
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Credit limit |
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| Notes: |
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| Name |
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Telephone area code and number |
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| Address |
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Credit limit |
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| Notes: |
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| List all sureties, cessation of debtors, notarial bonds, judgements |
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| List liquidations, sequestration's against the business or its principals |
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| Have moratoriums or offers of compromise ever been made to any creditors? |
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| Can the latest audited Financial Statements be made available? |
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| If yes, what year? |
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Surety offered to substantiate credit limit |
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| Account contact person |
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Order numbers used? |
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| Credit requested |
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