Funding Application Form
Company Details
Business Name
*
Industry
*
Type of Business
Sole Proprietor
Close Corporation
Pty (Ltd)
Partnership
Trading As:
Trading Address
Street Address
Postal Address
City
State / Province
Postal / Zip Code
Registration No
First Date Trading
Length of Ownership-Years
how many years?
Length of Ownership-Months
how many months?
Office Tel No
Alternative Office Tel No
Mobile No
Email Address
example@example.com
Alternative EmailAddress
example@example.com
Vat No:
Business Property/ Lease Information
Freestanding Building
Yes
No
Shopping Mall/ Centre and Name
Building
Owned
Leased
Other
Landlord Details
Contact Person
Company Name
Contact No
Alternative Contact No
Email Address
example@example.com
Monthly Rental Amount
Mortgage Details
Bank Name
Account Name
Account Number
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Banking Information
Account Number
Bank Name
Account Type:
Savings
Cheque
Other
Owner 1
Full Name
First Name
Last Name
Percentage of Owner(%)
Home Owner
Yes
No
ID No OR Passport No
Date of Birth
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Tel No
Mobile No
Owner 2
Full Name
First Name
Last Name
Percentage of Owner (%)
Home Owner
Yes
No
ID No OR Passport No
Date of Birth
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Tel No
Mobile No
Documents Required
• ID document •Bank statements (latest 3 months)
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Declaration
I have read, understood & agree to be bound by the terms and conditions that accompany this application form and declare that the information given above is true and correct. I agree and consent that Retail Capital may process, record or disclose my personal information, including details of my transactions, to: • Search credit bureau, credit reference and fraud prevention agency records • Comply with any laws or regulations • Include the name of your organisation in a list of customers • Contact you by any appropriate channel about products and services which we consider may interest you
Have any of the company principals been declared bankrupt or insolvent?
Yes
No
Are there any pending judgements against the business?
Yes
No
Signed on
-
Month
-
Day
Year
Date
Authorised Signatory Name
Designation
Signature
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