Your special ist steel supplier.

Does the company or any of the directors, members or sole proprietor have any credit issues, EG: Debt-councelling, structured debt-payments on pressing legal debt issues?

VAT No: 4750206510

Preferred Steyn Steel branch:

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Registration number of Legal Entity or ID if Sole Proprietor:

Details of: Sole Proprietor Member Director

newclient@steynsteel.co.za

I/we the undersigned: - warrant that all the information supplied is true and correct; - authorise Steyn Steel (Pty) Ltd to do identity and/or credit checks on the applicant; - stand personal surety for the credit should it be granted and understand that all goods remain the property of Steyn Steel (Pty) Ltd until fully paid; and - have the authority to bind the applicant hereto.

Signed at ________________________________________________ on this the___________________ day of ____________________________________ 20_______

Legal Name: Trading Name: VAT registration Please attach proof: Contact EMAIL: Tel Nr: Cell: Estimated monthly purchases: Credit required: Name: ID Nr: Designation: Physical Address: Name_2: ID Nr_2: Designation_2: Physical Address_2: Name_3: ID Nr_3: Designation_3: Physical Address_3: Auditors Name: Tel No: Bank Name: Branch CodeDescrip: Account no: undefined: on this the: day of: 20: Name Authorized Signatory: Date Signed: Name of Witness: Date Signed_2: Which SS Branch: [Select branch]Postal AddressRow1: Postal AddressRow3: Postal Code: Postal AddressRow2: Physical Address Please attach proofRow1: Physical Address Please attach proofRow2: Physical Address Please attach proofRow3: Physical Address Code: Trade 1: Trade 2: Trade 3: Terms Trade 2: Terms Trade 1: Terms Trade 3: Credit limit 1: Credit limit_2: Credit limit_3: Average 1: Average 2: Company Telephone 1: Company Telephone 2: Legal entity: Company Telephone 3: Average 3: Company Registration Number Please attach proof: Credit issues: OffTrade Acc 1: OffTrade Acc 2: OffTrade Acc 3: OffSettlement: OffInfo: OffLegal Entity: OffButton1: Click to email: