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
2023
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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Submit
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