Account Application

Account Application


Company Information
Full Registered Name - The body accepting full responsibility for settlement. If a Partnership, give name of partners. If a Limited Company, give full trading title of company.

Banking Details
Nature Of Business:*
Note: *s indicate mandatory fields


Primary Contact Details Note: If this credit application is approved, the primary contact specified below will be configured to transact on behalf of the company represented by this credit application.

Accounts Department Contact


Note: *s indicate mandatory fields


Account Requirements
Your Current Black Ecomonic Empowerment Status
Are you willing to provide security?
National Credit Act no. 34 of 2005
Is the applicant's asset value or turnover together with the combined asset value or annual turnover of all related juristic persons in excess of ZAR 1 000 000?
Postal/Invoice Address
Physical/Delivery Address

Registered Office Address (If Different)

Note: *s indicate mandatory fields


Trade References...
Trade References

Your Market Sectors
Note: To select multiple market sectors, please use Ctrl-click
Brands of interest

Note: To select multiple brands, please use Ctrl-click
Note: *s indicate mandatory fields



I hereby state I am a genuine retailer and any products purchased by me from Vermont Sales are for resale and not for my personal use. If I cease to trade as a retailer, I will inform Vermont Sales immediately and my account will be closed. Vermont Sales reserves the right to close my account if at any time it is discovered (or there are reasonable grounds to suspect) I am not a genuine retailer.

The information given is a true statement of the facts requested. Accounts are granted subject to status and a credit check with a third party.*

Vermont Sales' Terms and Conditions of Business

Vermont Sales' Privacy Policy

Note: *s indicate mandatory fields