KOOPKRAG SUPPLIER'S APPLICATION FORM
Registered Name of Business :
Trading as :
Type of Business (eg. Groceries) :
Physical Address of Business :
Shopping centre :
Suburb : Postal Code :
Postal Address :
Postal Code :
Telephone Number(s) : 1. 2.
Fax Number(s) : 1. 2.
E-Mail Address :
In case of a Partnership / Sole Ownership
Name(s) of Owner or Partners :
In case of a Company / Closed Corporation
(a) Names of Directors / Members :
(b) Company / Closed Corporation Registration Number :
VAT Registration Number :
Have you ever been a supplier of Koopkrag Limited? YES NO
Are you a supplier to any other Buying Associations? YES NO
If yes - Name them :
Language Preferred : AFR ENG
Bank Terminal : NEDBANK ABSA Terminal number :
Percentage Collection Fee : % (Determined by Koopkrag)
BANK DETAILS
Bank : Branch Name :
Account Number : Branch Code :
Account holders name :

If our application as a supplier is successful, we undertake to comply to all the conditions of this agreement and to supply our goods and/or services to Koopkrag members at our normal retail prices.

A supplier number will be issued as soon as a contract between Koopkrag Limited and the supplier is signed.

APPLICATION COMPLETED BY : Name
Title
Submission Date :

 

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