CREDIT APPLICATION FORM Received Friday, 06-Aug-2004 at 15:23:17.

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     % Shareholding / Interest  
 
Full name     I.D. Number  
Residential address     % Shareholding / Interest  
 
Full name     I.D. Number  
Residential address     % 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
Name     Telephone area code and number  
Address     Credit limit  
Notes:        
 
Name     Telephone area code and number  
Address     Credit limit  
Notes:        
 
Name     Telephone area code and number  
Address     Credit limit  
Notes:        
 
Name     Telephone area code and number  
Address     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?        
 
Can the latest audited Financial Statements be made available?        
If yes, what year?     Surety offered to substantiate credit limit  
Account contact person     Order numbers used?  
Credit requested        

form_06-Aug-2004_15-23-17.htm