Application for Credit


Please fill in this form if you are interested in credit. Please take note that this will take up to 10 working days.
Please note that ALL fields are required fields.

1. APPLICANT:
Account Number:   (Will be completed by the Betsa Offices)
Requested Credit: R
Full Names and Surname: Spouse's Names and Surname:
ID Number: Spouse's Id Number:
Postal Address:    
Physical Address:    
Mobile Phone: Spouse's Mobile Phone:
Work Telephone: Spouse's Work Telephone:
Home Telephone: Fax:
E-Mail Address:
Married: In Community of Property
Out of Community of Property

ASSETS:
1. Immovable Property a) Value: a)
b) b)
2. Motor Vehicles: a) Reg Number: a) Value: a)
b) b) b)

COMPANIES/CORPORATIONS/PARTNERSHIP/SOLE PROPRIETOR:
a) Name: b) Name:
Registration Number: Registration Number:
Address: Address:
Postal Address: Postal Address:
Telephone: Telephone:
Designation: Designation:
Share/Value: Share/Value:
Auditors: Auditors:
Telephone: Telephone:

EMPLOYMENT
Name:
Address:
Postal Address:
Telephone:
Contact Person:

ACCOUNT REFERENCES:
1. Name/Company: Account Number: Account Balance:
2. Name/Company: Account Number: Account Balance:
3. Name/Company: Account Number: Account Balance:

Banking Details (Required for settling purposes)
Account Name:
Account Number:
Account Type:
Bank Name:
Branch Name:
Branch Number:


THE APPLICANT, BY IT'S SIGNATURE HEREUNDER, AGREE AND ACCEPTS THAT IT'S CONTRACT WITH BET SA CC IS SUBJECT TO THE TERMS AND CONDITIONS OF THE AGREEMENT, ANNEXED HERETO AND ACKNOWLEDGES THAT IT IS BOUND THEREBY

Signed: Place:
Print Name: Date:
Witnesses:
1. Signature: Print Name:
2. Signature: Print Name:

   
**** REMEMBER TO PRINT THIS APPLICATION LANDSCAPE!!

Please download this pdf-file which stipulates the agreement terms and conditions.
Please print all and fax back to (013) 755 1270