COMPANY DETAILS:

Registered Name:

Trading Name:          Entity:           Close Corporation Private Company Partnership Sole Proprietorship Public Company (Pty) Ltd. Other   

Reg Number:            VAT Number:

Telephone:                Facsimile:    

Physical address:                                Postal Address:
          

E-mail Address:   

DIRECTOR / MEMBER / OWNER:

Name:                      I.D. Number:  

Telephone:               Email:      

Physical address:                                Postal Address:
          

KEY OPERATIONAL CONTACTS:

Title: Mr Mrs Miss Dr Prof    Name:    Position:

Telephone:               Email:      

Title: Mr Mrs Miss Dr Prof    Name:    Position:

Telephone:               Email:      

Title: Mr Mrs Miss Dr Prof    Name:    Position:

Telephone:               Email:      

BANKING DETAILS:

Bank:   Branch:   Code:

Account Number:     Telephone:

Prefered method of payment: Cash Bank Guaranteed Cheque EFT Pre Arranged

ACCOUNTANT:

Name:     Telephone:

TRADE REFERENCES:

Company:     Tel:     Credit:

Company:     Tel:     Credit:

Company:     Tel:     Credit:

Company:     Tel:     Credit:

I have read the terms and conditions: