Apply For Credit Facility

Complete the form below to submit a credit application.

Please note that all fields marked with an are required.

Which division are you applying to?

Company Details:

Legal Business Name:

Trading Name:

Type of Business:

Business Description:

Company Registration Number:

VAT Registration Number:

Business Start Date:

Expected Monthly Spend:

ZAR

Credit Limit Requested:

ZAR

Payment Terms Requested:

Director / Owner Details:

First Name:

Last Name:

Telephone Number:

+27

ID Number:

Date of Birth:

Ever Been Liquidated or Sequestrated?

Company Contact Details:

Address 1:

Address 2:

Suburb:

City:

Post Code:

Landline:

+27

Mobile:

+27

Fax:

+27

Email Address:

Banking Details:

Type of Bank Account:

Name of Account Holder:

Name of Bank:

Account Number:

Branch Code:

Trade References:

Supplier Business Name:

Supplier Contact Name:

Supplier Telephone:

+27

Secondary Supplier Business Name:

Secondary Supplier Contact Name:

Secondary Supplier Telephone:

+27

By submitting this form and registering my information with Crown National I recognise and I accept their terms and conditions.

Apply
For Credit Facility