Credit Assessment Application
Notes on completing this form
  • Please note that all information provided on this form is confidential and that certain information provided will be validated.
  • There is no obligation to supply all the information as stated on the application, however, it could influence your application.
  • Only original Credit Assessment Applications will be accepted – faxed or photo-copied forms are not acceptable.
  • All Credit Assessment Applications are forwarded to an accredited Credit Bureau for validation. The normal lead-time is 5 – 7 working days from the date of receipt by JKM Tool Distributors (Pty) Ltd.
Company Name 
*
Reg Number 
*
Postal Address 
*
Delivery Address 
*
Landline 
*
Accounts Contact 
*
Accounts Email 
*
Required Credit 
*
Directors Details
Director 
*
Contact Number 
*
Address 
*
Directors Details
Director
Contact Number
Address
Directors Details
Director
Contact Number
Address
Trade Reference Details
Trade Reference 
*
Trade Contact No 
*
Trade Reference
Trade Contact No
Trade Reference
Trade Contact No
Required Document Upload
Upload ID 
*
Choose file or drag & drop here
Upload Company Docs 
*
Choose file or drag & drop here
Vat Registration Document
Choose file or drag & drop here
Proof of banking 
*
Choose file or drag & drop here
Supporting documentation can also be e-mailed to mike@jkm.co.za
We hereby warrant that the above information is true and correct. We further acknowledge that the terms of credit granted are 30 days from date of statement – I confirm that I have read and accepted in totality the “JKM Industrial Supplies (Pty) Ltd Terms and Conditions” which are available on our website www.jkm.co.za
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