Username*
Email*
First Name
Last Name
Store Name*
https://dailyonlinesa.co.za/store/[your_store]
Are you applying as company or individual
Registered Company / Individual - Full Name: (As Stated on Registration Document or Id)
Trading as / Known as - Name
Registration / Id - Number
Vat / Sars Income Tax - Number
Legal Entity / Status
Upload Supporting Documents for Each of the Above. File max size 1Mb
Certified Registration Document / ID. File size max 1Mb
Certified VAT Registration Document / SARS Document. File max size 1Mb
Physical Address
Building Type
Company, Building Name and Floor Number
Street Number
Street Name
Suburb
Town / City
State / Country
Post / Zip Code
Postal Address
Same as Above
Building Type PA
Company, Building Name and Floor Number PA
Street Number PA
Street Name PA
Suburb PA
Town / City PA
State / Country PA
Post / Zip Code PA
Certified Proof of Address. File size max 1Mb
Collection Address
Provide the address where the courier will collect your products for delivery.
Street Address CA
Suburb CA
Town/City CA
Province
Post Code
Contact Info
Title Of Contact Person
Cell Number
Landline Number
Office / Work Number
Fax Number
Email
Website
Certified Proof of ID if Different to the Above. File max size 1Mb
Banking Details
Bank Name
Account Type
Account Holder Name
Account Number
Branch Name
Branch Code
Reference
Bank Confirmation Letter. File max size 1Mb
About
Type Of Industry / Place of Work
If Other, Please Specify
Are Your Goods Insured?
Number Of Trading Years
Describe Your Business / Products
Profile & Catalogue / CV. File max size 1Mb
Any Special T&C'S We Should Know About
List Certifications or Licenses If Applicable
How Many Employees Do You Have?
Supply At least 3 Trade References
Reference 1
R1 Name
R1 Number
R1 Contact Person
R1 Credit Limit
R1 Monthly Spend
Reference 2
R2 Name
R2 Number
R2 Contact Person
R2 Credit Limit
R2 Monthly Spend
Reference 3
R3 Name
R3 Number
R3 Contact Person
R3 Credit Limit
R3 Monthly Spend
Have You Been Denied A Loan In The Last 4 Years?
Have You Been Under Debt or Credit Review or Applied for Insolvency / Liquidation in the Last 4 Years?
BY SUBMITTING THIS FORM, I CERTIFY THAT THE INFORMATION PROVIDED HEREIN IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
How did you first hear about our marketplace?
If other, please specify source
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