Thola Zonke

MERCHANT APPLICATION

Merchant Name

Company Name

Registration Number

Tax Reference Number

VAT Number

Company Address

Contact Number

Email Address (used for all communication)

AUTHORISED DIRECTOR

Name

Surname

ID Number

Mobile Number

Email Address

NOMINATED BANK ACCOUNT

Account Name

Bank

Branch

Account Number

AUTHORISED USER (Persons allowed access to the System and responsible for onboarding and managing Members)

Name

Surname

ID Number

Mobile Number

Email Address

AUTHORISED USER 2 (OPTIONAL)

Name

Surname

ID Number

Mobile Number

Email Address

AUTHORISED USER 3 (OPTIONAL)

Name

Surname

ID Number

Mobile Number

Email Address

AUTHORISED USER 4 (OPTIONAL)

Name

Surname

ID Number

Mobile Number

Email Address

Terms and Service Level Agreement

I herewith confirm that I am duly authorised to accept the Terms and Service Level Agreement for and on behalf of the Merchant.

MERCHANT APPLICATION

AUTHORISED DIRECTOR

NOMINATED BANK ACCOUNT

AUTHORISED USER (Persons allowed access to the System and responsible for onboarding and managing Members)

AUTHORISED USER 2 (OPTIONAL)

AUTHORISED USER 3 (OPTIONAL)

AUTHORISED USER 4 (OPTIONAL)

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