info@brenmill.co.za // 0861 100 201

Application for Credit Facilities

Brenner Brands / Application for Credit Facilities

TERMS AND CONDITIONS OF PURCHASE FROM BRENNER BRANDS (PTY) LTD:
This is an application addressed to BRENNER BRANDS, to qualify for the granting of consent to purchase from BRENNER BRANDS upon the terms and conditions as set out herein, and against the furnishing of security as provided for herein. This application is to be completed and signed by the authorized director of the company, the managing member of the close corporation, or the individual applying in terms hereof.

    Please only fill in the form applicable to you.

    Company / Close Corporation / Partnership Details

    Registered Company / Close Corporation / Partnership Name:

    Trading name:

    Registration No:

    VAT Registration No:

    Period in operation:

    Monthly turnover:

    Main place of business:

    Registered Address:

    Delivery Address:

    Forklift Yes/No

    Postal Address:

    Postal Code:

    Account Contact name:

    Cellphone Number

    Phone Number

    Fax

    Details of Directors / Members / Partners

    Full Name:

    ID/ Passport No:

    Home address:

    Contact Numbers:

    Full Name:

    ID/ Passport No:

    Home address:

    Contact Numbers:

    Upload photos of the inside and outside of the shop.

    Please provide the particulars as indicated above on the below text block if your company / close corporation / partnership has more than three directors / members / partners, as the case may be.

    Others:

    Individual Applicant’s Details

    Full Names:

    Trading name:

    Identity number:

    Period in operation:

    Monthly turnover:

    Main place of business:

    Home Address:

    Postal Address:

    Postal Code:

    Account Contact name:

    Cellphone Number

    Phone Number

    Fax

    Marital Status:

    If married in community of property both spouses must complete and sign this application jointly.

    Trade & Credit References

    Bank Name:

    Branch Name:

    Branch Code:

    Account number:

    Creditors (No Cell numbers):

    Name:

    Tel. No:

    Acc Number:

    Name:

    Tel. No:

    Acc Number:

    Name:

    Tel. No:

    Acc Number:

    Landlord Name:

    Tel:

    Years at current premises:

    Are premises rented or owned:

    (Please supply rental / ownership contract)


    Auditors Name:

    Contact person:

    Tel No.:

    General Information

    Has the APPLICANT or any of its Directors/Members been declared insolvent or placed under liquidation within the last 5 years: Yes / No

    If Yes, provide particulars:

    Does the APPLICANT or any of its Directors/Members have any civil or criminal judgments against them or any suits pending? Yes / No

    If Yes, provide particulars:

    Anticipated monthly purchases:

    Monthly purchase limit applied for:

    Terms Required

    Election with regard to the delivery of the monthly statement:

    Post

    Fax

    In case of e-mail, please provide the appropriate e-mail address:

    Upload Supporting Documents

    By submitting this form, the individual voluntarily provides consent for a credit reference check to be carried out on them or the company they represent by a Brenner Brands staff member. They acknowledge that such a check does not infringe on any of their fundamental rights and accept that the credit reference check is part of the account application process in accordance with the POPIA Act.

    E-mail

    Please enter the OTP