Only for South African licensed venues / companies
Company Registration #:
VAT Registration #:
Contact Person (Financial):
Email Address (Financial):
Contact Person (Orders):
Email Address (Orders):
Monthly Credit Limit Required:
Full Name 1:
Full Name 2:
Full Name 3:
Please upload a copy of the following files below in either PDF, JPG or PNG format:
- Liquor License
- Company Registration
- VAT Registration
- ID of owner/s
(Combined maximum file size = 10MB)
Drag & Drop Files Here
Please wait for the document/s to finish uploading before pressing the submit button.
To be signed by Director / Member / Partner / Authorised Signatory:
On behalf of
Hereby certify awareness of this application and authorise a consumer scan, judgment check with Kreditinform on the id numbers contained in this report and theopening of an account in the name of the above Company / Close Corporation / Partnership / Proprietorship, subject to the Terms & Conditions of Trading of Ataraxia Wines.
Signed (Use your mouse cursor to sign here):
Accept Ts & Cs
Please make sure all the details are 100% correct before submitting.
If the form does not submit, please scroll up to see what needs to be corrected.