Company Name (required)
Registration Number
Existing Customer
YesNo
Account Number
Company Type
Pty LtdClose CorpOther
Street Address (required)
Postal Address (required)
Telephone Number (required)
Fax Number
Business Nature
VAT Number
Date Established
Period under current management
Contact Person (required)
Email Address (required)
Auditors Name
Auditors Contact Number
Bankers
Branch
Date
Insurers
Insurers Contact Number
Landlord
Landlord Contact Number
Postal Address
Full Name
ID Number
%
Residential Address
Purchase Price
Value
O/S Bond
Name
Contact Number
Account Number / Contract
I/We declare that to the best of my/our knowledge and belief, the particulars set out in this application are true and correct, and that no additional information was withheld. I/We consent to Mercantile Rental Finance making enquiries about my credit record any reference agency and any other party to confirm details on this application. I/We consent to Mercantile Rental Finance carrying out identity and fraud prevention checks and sharing information relating to this application with the South African Fraud Prevention Service.
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