PBSA (Pty) Ltd

Credit Application

PBSA (Pty) Ltd

Hi

Thank you for choosing PBSA, and welcome to our customer on-boarding system!

We have designed the system to make the activation process as efficient as possible, and to achieve this we will ask you to provide us with the information required to open your account with PBSA.

Please complete all the required fields accurately and completely, and upload the requested documents to facilitate the approval of your application.

Once you have provided us with the necessary information and documents we will forward the application to the relevant signatories in your organisation for signing, before submitting the details to our credit control department for approval and opening of your account.

If you have any difficulties with the application process, please do not hesitate to contact us on support@pbverify.co.za

Kind Regards,
PBSA Directors

STEP 1

Please provide details of person filling in the application form (You).

First name.

Surname.

Mobile Number.
The OTP code you have entered is not valid, please try again

Email Address.

Mobile Authentication OTP

Please enter the mobile OTP (One Time Password) received on your mobile phone.

Mobile OTP Code *

You can only resend the OTP up to three times.

Applicants Information

Please ensure that you answer all questions accurately.

Please choose one of the following

South African (PTY) LTD | CC | NPO *

South African Sole Proprietor *

South African Government/Parastatal *

Non South African Company/Proprietor *

ID Number

Business Reg #

The application documents will be sent to : , Please complete and send back to us via email.

Business Information.

VAT Questions.

Please answer all questions below.

Are you VAT Registered? *

VAT Number *

Business Details

Full Registered Name Applicant

Trading Name

Company Registration No

Address Details

Delivery Address *

Postal Address *

Registered Address

Contact Details - Purchasing Department

Name of person responsible
for purchasing *

Direct Number of Purchaser *

Mobile Number *

Email Address *

Contact Details - Accounts Department

Name of person responsible
for accounts *

Mobile Number *

Email Address *

Sales Executive:

Which PBSA (Pty) Ltd department are you dealing with?*

Credit Required

Total Credit Required *

Credit Terms required *

Auditors details

Auditors/Accountants *

Name of Directors of Company/Members of the Corporation

Full Names

ID Number

Contact Number

Trade References (At least 2)

Company *	Contact Number *	Account Limit *	Account No *

Business Banking Details

Upload Banking Letter *
No older than 3 months

Account Name

Bank Name

Branch Name

Branch Code

Account No

Account Type

Sole Proprietor Information

Please ensure that you answer all questions accurately.

Proprietor Details

Full Registered Name Applicant

New Full Registered Name Applicant

Trading Name

ID Number

Address Details

Delivery Address *

Postal Address *

Registered Address

New Registered Address

Contact Details

Please provide a landline number*

Cell No *

Email Address *

Sales Executive:

Which PBSA (Pty) Ltd department are you dealing with?

Business Banking Details

Account Name

Bank Name

Branch Name

Branch Code

Account No

Account Type

Is the person/s that is authorised to sign listed below? *

Full Name

ID Number

Valid Mobile Number

Email Address

Selection

Processing your application, Please be patient.

Final process.

Please be patient...

Credit Application

PBSA (Pty) Ltd

STEP 1

Mobile Authentication OTP

Please enter the mobile OTP (One Time Password) received on your mobile phone.

Applicants Information

Please ensure that you answer all questions accurately.

Business Information.

VAT Questions.

Business Information

Please ensure that you answer all questions accurately.

Sole Proprietor Information

Please ensure that you answer all questions accurately.

Authorised Signatory

Make your selection below

Processing your application, Please be patient.

Final process.

Please be patient...