Rental Credit Application Form
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RENTAL CREDIT APPLICATION
For Juristic Persons to whom the Consumer Protection Act does not apply
Schedule of Goods
Schedule of Goods:
Supplier
REG NO
Telephone
x
Type of Transaction:
Rental
Escalation
%
Months
Payment Period:
Rental
excl.
Installation Date:
Company Name:
REG
Close Corp.
Pty Ltd
Other
Company Type:
Street Address:
Postal Address:
Telephone No.:
Fax No.:
Business Nature:
Vat no:
Date Established:
Contact Person:
Financial Details
Auditors Name:
Phone:
Bankers:
Branch:
Account No.:
Date:
Insurers:
Telephone:
Landlord:
Telephone: / Fax
Directors / Members / Shareholders / Partners and / or Company Details
Full Name:
ID Number
Purchase Price
Value
O/S Bond
Trade References
ANNUAL TURNOVER OR NET ASSET VALUE
Name:
Telephone
Acc No / Contract
R ________________
Signature:____________________
Additional Information
WEBSITE ADDRESS
E-MAIL ADDRESS
I/We declare that to the best of my/our knowledge and belief, the particulars set out in this application are true and correct, and that no additional
information was withheld. I/We consent to Custom Capital making enquiries about my credit record any reference agency and any other party to confirm
details on this application. I/We consent to Custom Capital carrying out identity and fraud prevention checks and sharing information relating to this
application with the South African Fraud Prevention Service.
SIGNATURE:
DATE:
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Parent category: Business