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Company Information

Legal Entity Type

Legal Entity (In which entity do you operate in?)

Other Legal Entity

Legal Name

Trading Name

Company Registration Number

First Name(s)


South African Identity Number


Annual Turnover

Asset Details

Equipment Type


Description of Equipment

Article Type

Year of 1st Registration(CCYY)

Purchase Price (incl VAT)

Deposit(incl VAT)

Term in months

If Vehicle : Make


M & M Code

Contract Type

Contact Person Information

First Name(s)


Mobile Number

E-mail Address

Sales Person Information

If you have already engaged with a Dealer/Supplier, please complete the information below. (OPTIONAL)

Dealer/Supplier Name

Sales Person Name

Sales Person Surname

Sales Person Contact Number

Sales Person E-mail Address


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