Credit Approval – Bolt It

PLEASE COMPLETE THE FORM FOR CREDIT APPROVAL:

CREDIT APPLICATION FORM

FULL TRADING NAME *
REGISTERED NAME *
REG. NO *
BUSINESS ADDRESS *
POSTAL ADDRESS *
VAT NUMBER *
E MAIL ADDRESS *
TEL NO *
FAX NO
CELL *

NAMES OF DIRECTORS/MEMBERS

DIRECTOR/MEMBER: 1 *
ID NUMBER: *
ADDRESS *

DIRECTOR/MEMBER: 2
ID NUMBER:
ADDRESS

NATURE OF BUSINESS *
BUSINESS COMMENCED *
CREDIT REQUIRED *

TRADE REFERENCES

1:
1 TEL NO:
2:
2 TEL NO:
3:
3 TEL NO:

BANK DETAILS

BANK *
BRANCH *
ACCOUNT NO *
BRANCH CODE *
Accounts must be paid within the 30 day period stipulated. Failure to do so will result in additional charges for telephone/manual follow up and interest or closure of the account.

FULL NAME *
SIGNED AT *
Date *
FULL ADDRESS *
SIGNATURE *
TICKING THIS BOX ACTS AS MY FULL SIGNATURE

Verification

Please enter any two digits *Example: 12
This box is for spam protection - <strong>please leave it blank</strong>:

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