New Client Application

Block A, Agrihub Business Park
477 Witherite Road
Die Wilgers, Pretoria
Primary: 079 491 2139
Tel: 011 658 1485
Fax: 086 680 8781

Kindly Note that these details are confidential and will NOT be shared with a 3rd party.

Applicant Name and Surname

Email

Registered Company Name

Trading As Name

POSTAL ADDRESS:

STREET ADDRESS:

INVOICES TO BE SENT TO:

TELEPHONE NUMBER/S:

E-MAIL ADDRESS: (Buyer)

E-MAIL ADDRESS: (Accounts)

E-MAIL ADDRESS: (Management)

NATURE OF BUSINESS / INDUSTRY

DATE COMMENCED BUSINESS / INCORP’D:

REGISTRATION NUMBER

VAT NUMBER

DIRECTORS / MEMBERS / PARTNERS: Person 1

DIRECTORS / MEMBERS / PARTNERS: Person 2

I hereby confirm that the above is true and accurate

Applied on:

At:

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