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Client Application Form
Only fields with a * are mandatory
Are you registering a business or private
*
First Name of Applicant (Person Responsible for Payments)
*
Surname
*
Country
*
ID/Passport
*
Physical Address:
Street Address 1
*
Suburb
City
*
Province
*
Address Code
*
Postal Address
Postal Address 1
Postal Address 2
Postal Code
Business/Landline Number
Cellphone Number
*
Email address
*
Business Name (Trading Name)
*
Registered Business Name
*
Date Established
*
Registration Number
*
VAT Number
*
Type Of Company
*
Type Of Company
A
Public Company
B
Private Company
C
Closed Corporation
D
Partnership
E
Sole Proprietor
Financial Manager First Name
*
Financial Manager Surname
*
Financial Manager Contact Number
*
Financial Manager Email Address
*
(Who will receive invoices if different from above) Accounts Contact First Name
Accounts Contact First Surname
Accounts Phone Number
Accounts Email Address
Director 1 First Name
*
Director 1 Surname
*
Director 1 ID Number
*
Director 2 Name (If Applicable)
Director 2 Surname
Director 2 ID Number
Please read our Terms and Conditions
https://www.pcservices.co.
za
/TC/
I Have Read The Terms and Conditions
*
I Have Read The Terms and Conditions
Yes
By signing this you have read and agree to the Terms & Conditions
*
Signature
Signatory Name
*
Signatory Capacity
*
Please Confirm Signatory Date
*
Submit