Business Credit Application

APPLICANT INFORMATION

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Legal Business Name: {{legal_business_name}}

Trading Name (if different): {{trading_name}}

Business Registration Number: {{registration_number}}

Date of Incorporation: {{incorporation_date}}

Business Type: {{business_type}} (e.g., Sole Proprietorship, Partnership, Private Limited Company)

Nature of Business: {{nature_of_business}}

Primary Contact Person: {{primary_contact_name}}

Primary Contact Title: {{primary_contact_title}}

Primary Contact Phone: {{primary_contact_phone}}

Primary Contact Email: {{primary_contact_email}}

REGISTERED ADDRESS AND OPERATIONAL DETAILS

Registered Address: {{registered_address}}

Physical / Operational Address (if different): {{operational_address}}

Number of Employees: {{number_of_employees}}

Bank Name: {{bank_name}}

Bank Account Number: {{bank_account_number}}

Bank Branch: {{bank_branch}}

Account Manager (if applicable): {{bank_account_manager}}

CREDIT REQUIREMENTS

Requested Credit Limit: {{requested_credit_limit}}

Purpose of Credit: {{purpose_of_credit}}

Anticipated Monthly Spend: {{anticipated_monthly_spend}}

Preferred Payment Terms: {{preferred_payment_terms}} (e.g., 30 days, 60 days)

TRADE REFERENCES

Please provide details of at least three (3) trade references with whom you have established credit accounts.

Reference 1:

Company Name: {{trade_reference_1_company}}

Contact Person: {{trade_reference_1_contact}}

Phone: {{trade_reference_1_phone}}

Email: {{trade_reference_1_email}}

Reference 2:

Company Name: {{trade_reference_2_company}}

Contact Person: {{trade_reference_2_contact}}

Phone: {{trade_reference_2_phone}}

Email: {{trade_reference_2_email}}

Reference 3:

Company Name: {{trade_reference_3_company}}

Contact Person: {{trade_reference_3_contact}}

Phone: {{trade_reference_3_phone}}

Email: {{trade_reference_3_email}}

FINANCIAL INFORMATION

Please attach your most recent audited financial statements (Income Statement and Balance Sheet) for the past {{number_of_years_financials}} years.

Annual Turnover (last financial year): {{annual_turnover}}

Net Profit (last financial year): {{net_profit}}

Are there any outstanding judgments, bankruptcies, or insolvencies against the company or its directors? {{outstanding_judgments}} (Yes/No)

If Yes, please provide details: {{judgments_details}}

DIRECTOR/PARTNER/PROPRIETOR DETAILS

Please provide details for all directors, partners, or the proprietor.

Director/Partner/Proprietor 1:

Full Name: {{director_1_name}}

ID/Passport Number: {{director_1_id}}

Residential Address: {{director_1_address}}

Phone: {{director_1_phone}}

Director/Partner/Proprietor 2:

Full Name: {{director_2_name}}

ID/Passport Number: {{director_2_id}}

Residential Address: {{director_2_address}}

Phone: {{director_2_phone}}

TERMS AND CONDITIONS

The undersigned, by submitting this application for credit, hereby authorises {{creditor_company_name}} to investigate the credit worthiness of the applicant, including obtaining credit reports from credit bureaus or other financial institutions.

The applicant agrees that all goods/services purchased on credit shall be subject to the terms and conditions of sale of {{creditor_company_name}}, which are available upon request and may be updated from time to time.

The applicant agrees to pay all invoices within the agreed payment terms of {{payment_terms}} days from the invoice date. Overdue accounts may be subject to interest at a rate of {{interest_rate_percent}}% per month or the maximum rate permitted by law, whichever is lower, as well as collection costs.

The information provided in this application is true and correct to the best of my knowledge and belief.

This application does not constitute a guarantee of credit approval. All credit applications are subject to approval by {{creditor_company_name}}'s credit department.

DECLARATION AND AUTHORISATION

I/We certify that the information provided in this application is accurate and complete. I/We understand that this information will be used to assess our creditworthiness.

I/We authorise {{creditor_company_name}} to make enquiries as they deem necessary concerning our credit history and to obtain reports from credit bureaus, banks, and trade references.

I/We agree to notify {{creditor_company_name}} promptly of any material changes to the information provided herein.

SIGNATURE BLOCK

For and on behalf of {{legal_business_name}}

_________________________________________

Name: {{authorised_signer_name}}

Title: {{authorised_signer_title}}

Date: {{signature_date}}