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Please complete all the fields for the application to be considered.
To open your account we require the following documents:
*Proof of Identity - ID/Passport
*Proof of Income - Latest Payslip or Bank Statement
*Proof of residential address
Upon approval, Parktown Stores will determine your credit limit. When using your account for the first time, you will have to pay one third of the total value of your credit purchases.
The deposit may vary for high value items such as crossbows and bows. Credit limits to be determined by Parktown Stores. |
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Are you currently insolvent, under Debt Review OR under Administration
OR have you applied for Debt Review within the past two months? |
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Please select item from dropdown.
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| Title |
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Please select item from dropdown.
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| Name |
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Surname |
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| Email address |
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| Date of Birth |
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Must be in the format DD/MM/YYYY
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| Nationality |
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| Identity Type |
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Please select item from dropdown.
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| Identity Number |
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Must be 13 digits long.
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| Country of Issue |
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| Marital Status |
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Please select item from dropdown.
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If you are married In Community of Property or by Customary law, please confirm the
following: I warrant that I have my spouse’s consent to open this account with Parktown Stores |
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| I am married In Community of Property |
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| I am married by Customary law (prior to 15/11/2000) |
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Telephone numbers (please supply at least two contact numbers, one being a landline).
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| Home Telephone |
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| Work Telephone |
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| Cell Phone |
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Must be numeric and 10 consecutive characters (no spaces)..
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| Home Type |
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Please select item from dropdown.
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| Street Address |
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| Suburb |
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| city |
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| Postal Code |
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| How long at current address? |
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Please select item from dropdown.
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| How long at previous address? |
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Please select item from dropdown.
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| Email Address |
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Financial Details
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| Occupation |
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| Employment Status |
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| Employment Time |
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| Employment Type |
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| Name of Company/Educational institution |
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| Company/Educational institution address |
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| City |
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| Postal Code |
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| Duration at Present Company |
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| Duration at Previous Company |
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| Employee Number |
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| Gross Monthly Income |
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| Monthly deductions (tax, pension, medical aid etc) |
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| Monthly commitments (e.g. transport, school fees, household expenses) |
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| Debt obligations (e.g. credit accounts, personal loans etc) |
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| Total outstanding balances on debt obligations |
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| Spouse income amount |
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| Other monthly income |
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| Income Total |
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| Debt Total |
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| Variance |
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Next of Kin Details
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| Title |
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| Name |
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Surname |
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Relationship |
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| Home Telephone |
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| Cell Phone |
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