I have read and accepted the the terms and conditions.  

 I hereby make an application for credit facilities (herein referred to as "the applicant") with Eurotag (herein referred to as the "creditor")

* REGISTERED NAME

* TRADING NAME

* REGISTRATION NUMBER         * VAT Nr.

* NATURE OF BUSINESS           * DATE EST.

* ENTITY (Other) Public (PTY) Ltd. CC Partnership Sole Proprietor                    

* TEL           * FAX           * E-MAIL

* POSTAL ADDRESS        * DELIVERY ADDRESS

                                                                           

                                                                                          

                                 CODE                                                      CODE

* FULL NAMES OF MEMBERS/ PARTNERS/ DIRECTOR/ PROPRIETOR.

     ID Nr.      ID Nr.      ID Nr.      ID Nr.

* BANKING DETAILS:

* BANK         * BRANCH         * BRANCH CODE

* ACCOUNT Nr.           * CREDIT REQUIRED

* AUDITORS           * CONTACT Nr.

TRADE REFERENCES:

1          * TEL:           * MONTHLY PURCHASES

1          * TEL:           * MONTHLY PURCHASES

1          * TEL:           * MONTHLY PURCHASES

TERMS ARE STRICTLY 30 DAYS NET.

The applicant hereby applies for credit facilities with the creditor and in consideration thereof, the applicant, who's name appears on this application herewith irrevocably accepts the terms and conditions  (CLICK HERE) and warrants that all the information provided herein is true and correct in all respects.

* COMPLETED AT ON THE DAY OF IN THE YEAR

* COMPLETED BY           * I.D. Nr

I am authorized to apply for credit on behalf of the applicant. 

Please fax me a copy of the credit application including the terms and conditions.

Please contact me as soon as possible regarding this matter.

 I AM BEST CONTACTED BY      TELEPHONE     FASCIMILE     E-MAIL     POST