Application Form for COD Profile

Complete this form to apply for a Cash-on-Delivery account profile with Citilec. All fields marked with * are required.

Important: Submitting this form is the first step. You must also deliver a signed original along with certified copies of: CoR documents, VAT registration certificate, identity documents and proof of residential address for all directors/members/partners.

COD PROFILE APPLICATION

Citilec (Pty) Ltd · Reg. 2005/022163/07 · Tel: 011 334 2737

Business Details

Registered Name of Business *

Trading Name of Business

Previous Trading / Registered Names

VAT Registration Number

Registration Number of Incorporation

Registered Name of Holding Company

Names of Subsidiary & Associate Companies

Nature of Business Activities

Addresses

Physical Address *

Postal Address

Postal Code

Registered Address

Registered Address Code

Contact & Premises

Telephone (Area Code & No.) *

Fax (Area Code & No.)

Email Address for Creditors Dept *

Premises

Landlord Name & Tel Number

Address of Landlord

Landlord Contact Person

Details of Proprietors / Directors / Members / Partners

Complete details for all directors, members, or partners. At least one entry is required.

Full Name *

ID Number

Cellphone Number

% of Shareholding / Interest

Residential Address

Full Name

ID Number

Cellphone Number

% of Shareholding / Interest

Residential Address

Full Name

ID Number

Cellphone Number

% of Shareholding / Interest

Residential Address

Full Name

ID Number

Cellphone Number

% of Shareholding / Interest

Residential Address

Financial & Auditor Details

How Long Has the Proprietor(s) Owned the Business?

Auditors / Financial Officer's Name

Auditor Tel (Area Code & No.)

Banker's Details

Bank Institution

Branch

Account Name

Account Number

Date Opened

Standard Conditions of Sale

INTERPRETATION – Clause headings are for convenience only. "Invoice" means the invoice for goods supplied by Citilec. "Debtor" means any person indicated on the invoice. "Goods" means all items specified on the invoice. "The parties" means Citilec (Pty) Ltd and the Debtor.
CONTRACT – All goods are sold subject to this agreement, which constitutes the whole contract between the parties.
OWNERSHIP AND RISK – Ownership of goods does not pass to the Debtor until full payment is received. Risk passes to the Debtor immediately on dispatch from Citilec warehouse.
PRICES AND PAYMENT – Goods are payable in cash on delivery unless credit is granted in writing. Credit accounts are payable within 30 days of invoice. Interest of 2% per month applies to overdue accounts. The Debtor consents to the jurisdiction of the Magistrate's Court. The Debtor is liable for all legal costs of collection.
EARLY SETTLEMENT DISCOUNT – Not applicable to COD account profiles.
DELIVERY – Delivery dates are estimates only. Delivery is within Gauteng. Delivery outside Gauteng is for the Debtor's account. Payment is on actual quantity delivered. Claims for shortage must be made within 24 hours of invoice date.
RETURNS – No goods will be accepted for return without prior written consent. A handling fee of 15% (or higher if levied by Citilec's supplier) applies to all returns.
CESSION OF BOOK DEBTS – The Debtor cedes all rights to book debts to Citilec as security for amounts owing.
GENERAL PROVISIONS – Failure to enforce any term is not a waiver of rights. The Debtor is liable for all goods supplied regardless of credit limit.

Declaration

I, the undersigned, in my capacity as authorised representative of the Debtor and in my personal capacity:

I hereby warrant that I am duly authorised by the Debtor to make this application on its behalf and that the above information is true and correct.

I accept and agree to the Standard Conditions of Sale which form part of this COD application, and acknowledge having read and understood them.

I acknowledge that in the event Citilec supplies goods which are not immediately paid on invoice, I/We remain liable for any amount due and undertake to pay on demand.

I hereby consent to Citilec (Pty) Ltd utilising any information contained herein and disclosing same to any credit bureau for the purposes of assessing creditworthiness and reporting account conduct.

Print Name *

Capacity *

Signed At (City)

Supporting Documents Required

Please upload copies of the following documents. A signed original must also be submitted to your nearest Citilec branch.

Company / CC documents (CoR)
VAT registration certificate
Identity documents of all directors/members/partners
Proof of residential address of all directors/members/partners

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