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Credit Application

If you have any queries about this form  please contact the BIZTEC Finance Dept  on 031 569 6210 or email elaine@biztecgroup.co.za or click here to download the form

Schedule of Goods
 
Goods:
Installation Address:
 
Terms:
Rental Lease Other
Payment Period:   Escalation
Monthly PYMT:   Manner
   
Total Deal Value (Ex VAT):
 
Company Details
 
Name of Business
(Full Legal Styling
Nature of Business:
VAT No:
Contact Person:
Physical Address:
Holding Company:
FAX Number
Email
 
 
Partnership
PTY
LTD
 
Sole Prop
CC
Other
Date Established:
Registration No:
Period in Business:
Postal Address:
Subsidary Companies:
Telephone No:
 
Financial Details
 
Insurers:
Contact Person:
Telephone No:
Auditors:
Contact Person:
Telephone No:
Name of Bank:
Contact Person:
Telephone No:
 
Landlord:
Contact Person:
Telephone No:
Balance Sheet Available:
No Yes
Management accounts available for year:
 
Account No:
Branch Code:
Date Account was opened:
   
Details of Shareholders/Partners/Members/Directors/and/or Controlling Company Details
   
1. Full Names:
2. Full Names:
3. Full Names:
4. Full Names:
 
1. Identity No:
2. Identity No:
3. Identity No:
4. Identity No:
   
Trade References
   
1. Full Names:
Telephone No:
2. Full Names:
Telephone No:
3. Full Names:
Telephone No:
 
Account No:
Contact Person:
Account No:
Contact Person:
Account No:
Contact Person:
     
Lease Installment References
     
1. Bank:
Account No:
2. Bank:
Account No:
3. Bank:
Account No:
 
Branch Name:
Current / Paid Up:
Branch Name:
Current / Paid Up:
Branch Name:
Current / Paid Up:
     
Declaration
     
"I/We hereby consent to Biztec Finance or its cessionary making enquiries about my/our credit record with any credit reference agency and any other party to confirm the details of this application. Biztec Finance or its cessionary may also provide credit reference agencies with regular updates regarding how I/we manage my/our account, including my/our failure to meet agreed terms and conditions. I/We consent that credit reference agencies may, in turn, make the records and details available to other credit grantors. Biztec Finance or its cessionary
     
   
Client Name:
 
Capacity:
Signed on date: