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Credit Application Form
Applicants Name
Registered Name
Trading Name
Telephone
Mob. No 1
Mob. No 2
Registration No
Fax No
VAT/TPIN No
Email
*
Nature of Business
Years Trading
Type of Business
Public Co
Pvt. Co
Partnership
Others
Please Specify
Postal Address
Delivery Address
Who will be maintaining the account for payment - Name and Surname
Business Premises
Owned
Leased
Rented
Auditors
Fixed Property in the name of applicant
YES
NO
Bonded
YES
NO
Bond Holder
Address
O/S Bond
2nd Bond Reg
YES
NO
2nd Bond Reg:
Date
Directors / Members of Applicant
First Name
Last Name
ID/NRC No
% Shares
Affiliations/Other Business Interests
First Name
Last Name
ID/NRC No
% Shares
Affiliations/Other Business Interests
Banking Details
Name of Banker
Branch Address
Branch Code
Account Name
Account Number
Account Type
SWIFT Code
Account Currency
Branch Address
Has the Applicant or any of it's Owners / Partners / Directors ever been declared insolvent, placed under debt administration, or, applied for or been subject to any form of debt rearrangement?
Yes
No
If yes please provide details
Company Details
Account Number Allocated
Postal Address
Postal Code
Mobile Number
Telephone Number
Fax Number
Contact Person
Vat Reg Number
Credit Limit Required
Trade References Check List
Trade Reference 1 Company Name
Contact Person
Position
Telephone Number
Credit Insurance
Credit Limit
Average Monthly Purchases
Code and Owners
Payment terms
Payment performance
How long have "they" had the account with your company?
Yes
No
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