COD DEALER APPLICATION FORM

IMALI-CORP 151 PTY LTD T/A OMEGA AFRICA IT SOLUTIONS

Registration Number 2022/587330/07 Vat Number4600265179

COD DEALER APPLICATION FORM

COMPANY INFORMATION

Name of Company *

Invoice Address *

Apartment, suite, etc *

City *

State/Province *

ZIP / Postal Code *

Country *

Delivery Address *

Apartment, suite, etc *

City *

State/Province *

ZIP / Postal Code *

Country *

Company Registration Number *

Bank Details

Bank Name *

Branch Code *

Account Name *

Account Number *

Contact

Name of Owner/Manager *

Phone *

Email Address *

Name for Accountant *

Phone *

Email Address *

Payment

Select the Method of Payment *CASHBANK TRANSFER

Turnover

Turnover this year *

ZAR

Turnover previous year *

ZAR

Company Creation Date *

Date FY End *

Full Name *

Date *

Job Title / Role *

Upload company Registration *

Upload Vat Registration *

Upload Directors ID *

I understand that submitting this form electronically constitutes a legally binding declaration.The information provided in this application is true and accurate.I am either the owner of the business or an authorized representative acting on behalf of the owner.I have the authority to submit this application and agree to the terms and conditions on behalf of the company.

THE ABOVE APPLICATION FORM IS NOT A CREDIT APPLICATION FORM. IN TERMS OF THE NEW NATIONAL CREDIT ACT OF SOUTH AFRICA A SEPERATE CREDIT APPLICATION FORM MUST BE COMPLETED BY A COMPANY WHEN APPLYING
FOR CREDIT. A CREDIT FACILITY CAN ONLY BE GRANTED IF CGIC APPROVES A CREDIT LIMIT AND A CREDIT TERM THIS IS A DEALER APPLICATION FORM AND ALL CUSTOMERS TRADE ON A C.O.D BASIS.

COD DEALER APPLICATION FORM

IMALI-CORP 151 PTY LTD T/A OMEGA AFRICA IT SOLUTIONS

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