Username*
Email*
Please check your junk mail as well!
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
Name*
Number*
Contact Person*
Credit Limit*
Monthly Spend*
Reference 2
Name*
Number*
Contact Person*
Credit Limit*
Monthly Spend*
Reference 3
Name*
Number*
Contact Person*
Credit Limit*
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
Password*
Confirm Password*
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