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Company Name
*
Name
*
Surname
*
Email
*
Contact Number
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Is your company's annual turnover above R1 000 000.00?
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Yes
No
Describe the nature of your business
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Specify the capital amount required (R)
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Specify the purpose for which you require business financing
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Expected duration you would require this capital (months)
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Select the type of assets you have to offer as collateral
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Property
Other
None
Where did you hear from us?
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Internet
From a Friend
Email
Social Media
Event
Publication
Other
Other (please specify)
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Any additional information
Subject
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