Dealer Application Form
Dear Valued Customer, In order for the application to be approved we will need the following: 1. Copy(s) of Director(s) Green Barcoded Identity Documents. 2. Cancelled Cheque or letter from the bank stating you have an open bank account. 3. Letter of in-corporation or CK documents. 4. Signed consent form attached to perform an ITC check. *Are You A Reseller or End User ?
Are you a reseller or end user ?
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Company Name
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Trading Name
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Holding Company
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Premises
Own
Bankers
Branch Code
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Account Type
Branch Name
Account Number
Branch Name
Details of Directore
Full Name & Surname
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Member 1 - Name & Surname
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First Name
Last Name
ResidentialAddress
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Member 2 - Name and Surname
First Name
Last Name
Member 2 - Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Member 3 - Name and Surname
First Name
Last Name
Member 3 - Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Member 4 - Name and Surname
First Name
Last Name
Member 4 - Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
File Upload - Member 1 - Green Barcoded ID
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File Upload - Member 2 - Green Barcoded ID
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File Upload - Member 3 - Green Barcoded ID
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File Upload - Member 4 - Green Barcoded ID
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File Upload - Cancelled Cheque or Bank Letter
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File Upload - Business Registration Paperwork
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*
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