Important Notice

Only fully completed applications will be vetted. You can either download the PDF or complete it online below. 

Client Application

Client Application

Account Contact Person
Account Contact Person
First
Last
Premises
Name of Landlord
Name of Landlord
First
Last

Banking Details

Details of Directors / Members / Partners

Please provide Name, Address, Tel No. and ID number for each person below.

Person 1

Person 2

Person 3

Person 4

Person 5

Trade References

1. Trade Reference
2. Trade Reference
3. Trade Reference
Can the latest Financial Statements be made available
Your Contact Person
Your Contact Person
First
Last
I, 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.
Name
Name
Full Name(s)
Last