Application: purchase order finance. Application: Purchase Order Finance. fill out the form Please only fill out this form if you were referred to The X Quotient by a particular person. If you were not referred by anyone, please fill out the form on this page: https://thexquotient.com/application-form/ APPLICATION: PURCHASE ORDER FINANCE - LEAD PROVIDERPlease enable JavaScript in your browser to complete this form.Please specify the Name and Surname of the person who referred you to The X Quotient: *FirstLastPlease specify the Phone Number of the person who referred you to The X Quotient:Please indicate amount of financing required (R) *Directors of the CompanyIf you have more than 4 directors in your company, please email us at pieter@thexquotient.comPlease indicate the number of directors in the company:1234PERSONAL CONTACT INFORMATION - DIRECTOR 1TitleFull Names *Surname *Country of Citizenship *ID/Passport Number *Residential Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodePostal Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCell Phone Number *Email Address *EmailConfirm EmailMarital Status *SingleMarriedMarriage TypeMarried - In Community of PropertyMarried - ANC With AccrualMarried - ANC Without AccrualCustomary MarriageHave you ever been declared insolvent / sequestrated? *NoYesPlease provide more information.PERSONAL CONTACT INFORMATION - DIRECTOR 2TitleFull NamesSurnameCountry of CitizenshipID/Passport Number *Residential AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodePostal AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeCell Phone NumberEmail AddressEmailConfirm EmailMarital StatusSingleMarriedMarriage TypeMarried - In Community of PropertyMarried - ANC With AccrualMarried - ANC Without AccrualCustomary MarriageHave you ever been declared insolvent / sequestrated? *NoYesPlease provide more information.PERSONAL CONTACT INFORMATION - DIRECTOR 3TitleFull NamesSurnameCountry of CitizenshipID/Passport Number *Residential AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodePostal AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeCell Phone NumberEmail AddressEmailConfirm EmailMarital StatusSingleMarriedMarriage TypeMarried - In Community of PropertyMarried - ANC With AccrualMarried - ANC Without AccrualCustomary MarriageHave you ever been declared insolvent / sequestrated?NoYesPlease provide more information.PERSONAL CONTACT INFORMATION - DIRECTOR 4TitleFull NamesSurnameCountry of CitizenshipID/Passport Number *Residential Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodePostal AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeCell Phone NumberEmail AddressEmailConfirm EmailMarital StatusSingleMarriedMarriage TypeMarried - In Community of PropertyMarried - ANC With AccrualMarried - ANC Without AccrualCustomary MarriageHave you ever been declared insolvent / sequestrated?NoYesPlease provide more information.BUSINESS CONTACT INFORMATION Company Name *Company Registration Number *Company Type *Sole proprietorshipPartnership(Pty) Ltd or CCOtherBusiness NumberBusiness Email AddressEmailConfirm EmailVAT NumberIncome Tax NumberBusiness AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodePostal AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeDate Business Commenced: *How long have you been at this address?BANK DETAILSBank Name *Branch Code *Account Number *Type of Account *Savings CurrentOtherDetails of all Current Loans or SuretiesIs the company currently involved in or have any pending litigation against it?Is the company under Business rescue or intend entering Business rescue proceedings in the next 3 months? *NoYesPURCHASE ORDER TRANSACTION INFORMATIONProcuring Entity *Physical Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCell Phone Number *Email Address *EmailConfirm EmailPurchase Order Value *Purchase Order Number *Purchase Order Expiry DateHave you supplied this customer before? *YesNoHave you been to the customer’s premises? *YesNoDOCUMENTATION REQUIREDCompany Registration Documentation - CIPC COR14.3 or CK2 * Click or drag a file to this area to upload. Certified Copies of all Director’s ID’s (Not older than 3 months) * Click or drag files to this area to upload. You can upload up to 4 files. FICA proof of residence for Directors (Not older than 3 months) Click or drag files to this area to upload. You can upload up to 4 files. FICA proof of residence for the Company (Not older than 3 months). Bank Statement etc. Click or drag files to this area to upload. You can upload up to 4 files. SARS Tax clearance certificate – Company and Individuals Click or drag a file to this area to upload. If applicable, proof of CSD Summary Registration Report Click or drag a file to this area to upload. Copies of Purchase Orders including full item specifications. * Click or drag files to this area to upload. You can upload up to 10 files. Copies of Supplier quotes/invoices for goods to be supplied. * Click or drag files to this area to upload. You can upload up to 10 files. Bank Account Confirmation Letter Click or drag files to this area to upload. You can upload up to 10 files. HOW DID YOU HEAR ABOUT US?Please SpecifyReferred by a friend/colleagueReferred to us by a supplier or departmentFacebookInstagramGoogleLinkedinOtherSingle Line TextTerms & ConditionsPlease read through all important information and confirm below. (Link to privacy policy at bottom of page). *I have read and understand the Declaration, Authority to Conduct Credit Search and the Privacy Policy below.Apply For Funding
