Important NoticeOnly fully completed applications will be vetted. You can either download the PDF or complete it online below. DOWNLOAD APPLICATION Client ApplicationClient Application Trading Name of Business Registered Name of Business Type of Entity: Private CompanyClose CorporationPublic CompanyPartnership Co. Registration No. Date of Commencement Registered Name of Holdings Company V.A.T Registration No. No. of Years in Business Business Activities Physical Address Postal Address Phone Fax Mobile Account Contact Person Account Contact Person First First Last Last Email Premises owned leasedName of Landlord Name of Landlord First First Last Last Phone of Landlord Banking Details Bank Account Name Branch Account No. Details of Directors / Members / PartnersPlease provide Name, Address, Tel No. and ID number for each person below.Person 1 Name Address Email ID number Person 2 Name Address Email ID number Person 3 Name Address Email ID number Person 4 Name Address Email ID number Person 5 Name Address Email ID number Trade References1. Trade Reference Name Phone 2. Trade Reference Name Phone 3. Trade Reference Name Phone Can the latest Financial Statements be made available yes no Year Type of Products Required Period of Rental Your Contact Person Your Contact Person First First Last LastI, the undersigned accept the Standard Terms and Conditions as per the signed Rental Agreement Contract. The customer acknowledges that any amount due for goods or services will be due unconditionally within the approved credit period from the date of an invoice being issued by the Company. Payment by cheque: The customer hereby declares that no cheques will be issued in payment unless there are sufficient funds available and that such funds will remain available in order that all cheque payments will be honoured and that under no circumstances will any cheque be stopped. The signatory hereby warrants by his signature hereto in the event of the customer being a Company or Close Corporation, that he is duly authorized to enter into this Agreement on the said terms and conditions on behalf of the customer and furthermore, in that event, by his signature hereto binds himself as a surety and co-principal debtor in solidium with the customer in favour of Dial-a-PC cc for the due and punctual fulfilment of the customers obligations under this agreement. 1. The contract holder hereby gives his / her consent for a credit check. 2. Outstanding accounts are subject to default listing on a national credit bureau database. 3. Dial-a-PC cc reserves the right to provide a national credit bureau with updated personal information. 4. The contract holder also consents that Dial-a-PC cc may use a national credit bureau database for tracing, should the contract holder abscond. 5. The contract holder hereby agrees that should they default on payment, Dial-a-PC cc can make this information available to the industry and affiliated businesses. I accept all terms and hereby certify that all the above information is correct.Name Name Full Name(s) Full Name(s) Last Last ID number Location Today's Date If you are human, leave this field blank. Submit
