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Mandatory fields are marked with *

Company Details

Company Name *

Company Registration Number *

VAT Registration Number

(Optional)

How long have you been in business? (Years) *

Company Contact Info (Email Address & Contact Number) *

Main Business Industry *

Company Registered Address

(Optional)

Director (Full Name)

(Optional)

Director ID Number

(Optional)

Director Phone Number

(Optional)

Transaction Details

Are all SARS obligations up to date? *

(VAT. PAYE and IncomeTax)

Average Monthly Turnover (R) *

Monthly Estimated Amount Required (R) *

Total outstanding debtor value (R) *

Payment Terms from Debtors (Days)

(Optional)

List your 2 largest debtors (and average sales p/m)

(Optional)

Are the debtors ceded to any institution? (Yes/No) *

(If YES, to whom?)

Does the company have any insurance over debtors? (Yes/No)

(If YES, provide)

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