B2B Application

COMPANY INFORMATION

Registered Name

Trading Name

Venue Type

Type of Registration

Year Established

VAT Registration Number

Company Number

VAT Certificate and Company Registration

Company Physical Address

Company Postal Address

Registered Office of Company

CONTACT INFORMATION

Tel Number

Cell Number

Fax Number

Email Address

DIRECTORS INFORMATION

Director 1 Full Name

Director 1 Capacity

Director 1 Residential Address

Director 1 ID Number

Director 2 Full Name

Director 2 Capacity

Director 2 Residential Address

Director 2 ID Number

Director 3 Full Name

Director 3 Capacity

Director 3 Residential Address

Director 3 ID Number

Director 4 Full Name

Director 4 Capacity

Director 4 Residential Address

Director 4 ID Number

SHAREHOLDERS INFORMATION

Shareholder 1 Full Name

Shareholder 1 Residential Address

Shareholder 1 ID Number

Shareholder 2 Full Name

Shareholder 2 Residential Address

Shareholder 2 ID Number

Shareholder 3 Full Name

Shareholder 3 Residential Address

Shareholder 3 ID Number

ACCOUNTS INFORMATION

Accounts Full Name

Accounts Email

Accounts Tel

MARKETING INFORMATION

Marketing Full Name

Marketing Email

Marketing Tel

BANKING INFORMATION

Bank Name

Branch Number

Branch Name

Account Number

Date Account Opened

TRADE REFERENCES

Reference 1 Name

Reference 1 Number

Reference 2 Name

Reference 2 Number

CREDIT AND WARRANT

On behalf of the aforementioned company, I warrant that the above information is true and correct.

I have read and accept the wholesale terms and conditions.

Credit Limit Requested

Duly Authorised Name

Duly Authorised Capacity

Date

SURETYSHIP

The below members bind myself/ourselves as surety/sureties to and co-principal debtor(s) with the following business:
(hereinafter referred to as "the debtor")
to LiquidConcepts Trading (Pty) Ltd, REG No: 2015/005129/07, (hereinafter referred to as the "creditor" for amounts which are owed by the debtor to the creditor or which may in future become owing from whatsoever cause arising without any limitation whatsoever.
I/We hereby renounce the benefits of the legal exceptions of division and excussion, no benefits received and non numeratae pecuniae and I/we hereby undertake to pay any amount which I/we may lawfully required to pay hereunder to the creditor within 7 (seven) days of being called upon so to do.
I/We hereby agree to the jurisdiction of the Magistrate's Court having jurisdiction over my/our person(s) in any action arising from this suretyship.
I/We also undertake to pay all legal costs incurred by the creditor in any proceedings instituted against me/us hereunder on an attorney and client scale together with the interest on the capital sum at the maximum rate allowed by law from time to time plus collection commission.
For the purpose of this suretyship I/we hereby choose the above mentioned address as my/our domicilium citandi et executandi.

Surety 1 Full Name

Surety 1 Address

Surety 1 ID Number

Surety 2 Full Name

Surety 2 Address

Surety 2 ID Number

B2B Application

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