Details of applicant:
First name and surname
*
Full company name
*
Department
Business form
*
- Select -
Sole proprietor
Partnership
CC
Pty Ltd
Ltd
Inc
Section 21 (not for profit) company
Government department
Municipality
State enterprise
Statutory body
Company reg. number
*
Date of registration
*
VAT reg. number
*
No. of years trading
*
Credit limit applied for (R)
*
Names of sole proprietor / members / partners / directors / CEO / COO / CFO of the applicant:
1. Full name
*
1. Identity number
*
2. Full name
2. Identity number
3. Full name
3. Identity number
Business address and contact details of the applicant:
Physical address
*
Suburb / town
*
Area code
*
Country
*
Postal address
*
Suburb / town
*
Postal code
*
Country
*
Tel number
*
Email address
*
Website address
Trade references for the applicant:
1. Company name
*
1. Contact person
*
1. Contact phone
*
1. Contact email
*
2. Company name
*
2. Contact person
*
2. Contact phone
*
2. Contact email
*
3. Company
*
3. Contact person
*
3. Contact phone
*
3. Contact email
*
Terms and conditions: The applicant hereby applies to open a 30 day credit account with EE Publishers with a credit limit as indicated above. The applicant accepts EE Publishers' Standard Terms of Sale for End-Clients published at http://www.ee.co.za/about/terms-of-sale/standard-terms-sale-end-clients
Terms and conditions
*
Confirmed and accepted
Authorisation: The applicant hereby declares that the information given in this form is true and correct in all respects, and confirms that the applicant is duly authorised hereto.
Authorisation
*
Confirmed and accepted