Application for Business Finance
Business Details
Section Three
Section Five
Date of application:
Where did you hear about Capx?
Please select
Google Search
Marketing email
From a friend
Other
Please specify:
Business Details
Business Type:
Please select
Company
CC
Trust
Partnership
Sole Proprietor
Business trading name:
Registered name:
Registration number:
In business since?
Please select
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Older
Physical Address:
Postal Address (if different):
Tel:
Product / service you provide:
(Please provide a detailed description)
Your 3 largest debtors:
1)
2)
3)
How much do you need from us?
R
Have you done discounting or factoring before?
Yes
No
State the name of the Financier:
Have you ceded your debtors book before?
Yes
No
State to whom debtors were ceded:
Do you have a bank overdraft facility?
Yes
No
State the name of your Bank:
Amount of overdraft (if applicable):
R
Current debtors book:
R
Monthly turnover:
R
Current creditors book:
R
Auditor or Accountant
Firm Name:
Contact Person:
Email:
Tel:
Details of person submitting this application:
Name and Surname:
Position:
Email:
Cell:
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Details of directors/members/trustees or partners.
How many directors/members/trustees or partners are there ?
1
2
3
4
5
Full Name:
Full name:
ID no:
Cellphone no:
Physical address:
Email:
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Company responsible for invoice payment - your client
How many large clients do you have?
1
2
3
4
5
Please provide details of each client
Company Name:
Company name:
Registration number:
Physical address:
Postal address (if different):
Contact person:
Tel:
Email:
Cell:
Average amount invoiced
per month:
R
Payment Terms:
Please select
15 days
30 days
45 days
60 days
90 days
120 days
Other
Please Specify:
How long have you been a supplier to this client?
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