The Grocery Express (Pty) Ltd Credit Application Form

The Grocery Express (Pty) Ltd

Credit Application Form
Company Information
Registered CompanyClosed CorporationPartnershipSole ProprietorOther
Registered Name Of Company*
Trading Name*
Principal Place Of Business (Physical Address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Delivery Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registration Number*
Vat Number*
Business Tel Number*

Area CodePhone Number
E-mail for Statements*
example@example.com
Email for Invoices*
example@example.com
Accounts Payable Contact*

First NameLast Name
ID Number*
Position Held*
Cellphone*

+27
Bank Information
Bank Name*
ABSA
Branch Code*
Bank Account Number*
Credit Required
Expected Monthly Purchases*
Credit Limit 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*
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*
Please Upload The SUPPORTING Documents As Set Out In Checklist Below*

Browse Files
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Upload Proof Of AddressUpload Company Registration DocumentsUpload Vat Registration CertificateUpload Copies of ID's of Each Director/Partner/Proprietor/OwnerUpload Bank Account Confirmation
Enter the word as it's shown*
Date*

MonthDayYear
Date
Authorized Signature*

Clear
I CONSENT TO A CREDIT CHECK
Take a Selfie Holding your ID CARD*
Approval Status*
Result
Credit Bureau*
Debt Cover*
Should be Empty:

The Grocery Express (Pty) Ltd

Company Information

Bank Information

Credit Required

Agreement