The Grocery Express (Pty) Ltd
Credit Application Form
Company Information
Company Type
*
Registered Company
Closed Corporation
Partnership
Sole Proprietor
Other
Registered Name Of Company
*
Trading Name
*
Upload Proof of Address
Principal Place Of Business (Physical Address)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Delivery Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Upload Company Registration Documents
Registration Number
*
Upload Vat Registration Certificate
Vat Number
*
Business Tel Number
*
-
Area Code
Phone Number
E-mail for Statements
*
Email for Invoices
*
example@example.com
Accounts Payable Contact
*
First Name
Last Name
Upload Copies of ID's of Each Director/Partner/Propriotor/Ownwer
ID Number
*
Position Held
*
CEO
CFO
DIRECTOR
MEMBER
OWNER
Cellphone
*
-
+27
Bank Information
Upload Bank Account Confirmation
Bank Name
*
ABSA
BIDVEST
CAPITEC
DISCOVERY
FNB
INVESTEC
NEDBANK
STANDARD
ABSA
Branch Code
*
Bank Account Number
*
Credit Required
Expected Monthly Purchases
*
Credit Limit Required
*
Terms Required
*
COD (Payment Due Before Delivery)
7 Days (Payment Due within 7 Days From Invoice)
14 Days (Payment Due within 14 Days From Invoice)
30 Days Net (Payment Due within 7 Days From Statement)
30 Days (Payment Due within 30 Days From Statement)
Sales Representative
*
Anja Tait
Benita Grobbelaar
Christo Bonthuys
Debbie Ballantine
Demar
Fanie Conradie
JJ Du Toit
Lynn Moore
Lucky
Nicole
Agreement
(By checking these boxes you are agreeing to our terms - should you have any questions please contact us) Please contact your sales representative.
Please Scroll Down To Read
*
Please Scroll Down To Read
*
Enter the word as it's shown
*
Date
*
-
Month
-
Day
Year
Date
Authorized Signature
*
I CONSENT TO A CREDIT CHECK
Take a Selfie Holding your ID CARD
*
Approval Status
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Approved
Not Approved
Result
Credit Bureau
*
Inoxico
Credit guarantee
Debt Cover
*
YES CGIC
NO DECLINED
Submit
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