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BRIEKDRAAI BELEGGINGS (PTY) LTD

Reg.No: 2000/006076/07

T/A

PONGOLA COLD STORAGE

VAT/BTW: 4540189372

Tel: (034) 413-2813 30 Klasie Havenga Str

Faks: (034) 413-2335 P.O. Box 564

PONGOLA

Email: kpostma@mwebbiz.co.za 3170

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CREDIT

APPLICATION

APPLICATION FOR CREDIT

1. CONSUMER DETAILS:

NAME OF CONSUMER: ...............................................................................................

Form of business: Public Company Private Company Close Corporation

Partnership Sole Proprietorship

Other: Specify:......................................................................................

CIPRO Number or Other Registration Number: ................................................................

If Sole Proprietor or Partnership:

Full name of owner or Managing Partner: ............................................................................

Identity Number: ...................................................................................................................

Date of registration:...................................Date of Commencement: ..............................

Supply copy of:

Companies: Form CM1 or CM3: Certificate of Incorporation; and

Form CM46: Certificate to Commence Business Close Corporation:

Form CKI and, if details were amended,

Form CK2 or CK2A

For Sole Proprietor or Partnership:

Trading License

Value Added Tax Number: ................................................................................................

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2. CONTACT DETAILS:

Addresses: Physical: ………………………………… Postal Address: ….……....................................

………............................................ ………………………………

…………………………………… ……………………………….

Telephone numbers: Code: .......................... Number:……………………………...

Code: .............................................................. Number:……………………………...

Fax Numbers: Code:......................... Number:……………………………...

Code .. . .......................................................... Number:……………………………...

E-mail Address:........................................................................................................................

BANKING DETAILS:

Name of Bank: ............................................................. Branch: .........................................

Account Number: ……………………………………..Branch Code: ................................

Account Holder: ...................................................................................................................

BUSINESS PREMISES: If the premises are rented

Name of Landlord: ...............................................................................................................

Telephone number: Code: .........................................Number: ...........................................

If premises are owned

Description: ...........................................................................................................................

Name of mortgagee: ..............................................................................................................

ACCOUNTANTS / AUDITORS External Auditors (For Companies) .....................................................................................

Contact Numbers .................................................................................................................

Accounting Officer (For Close Corporations) .....................................................................

Contact Numbers ………………………...............................................................................

REQUESTED CREDIT LIMIT R ...................................................................................

TERMS: ..............................................................................................................................

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TRADE REFERENCES (CURRENT)

Name Address Tel no

1. ……………………… …………………………. ……………

2……………………….. .………………………… ……………

3……………………….. …………………………. ……………

DETAILS OF DIRECTOR/S

MEMBERS

Name Address Tel no

1………………………. …………………………. …………….

2………………………. …………………………. …………….

3………………………. …………………………. ……………

Does the Consumer’s net asset value exceed R 1 000 000 ? ………

Does the Consumer’s annual turnover exceed R 1000 000? ………

Does the value of the agreement exceed R250 000? ………

I/We agree that the information supplied is true and correct and undertake to notify the Credit

Provider immediately in writing of any change in ownership or details contained herein.

IF ANY PORTION OF THE CONSUMERS DEBTORS OR ASSETS IS CEDED TO

ANOTHER PARTY, PLEASE COMPLETE:

DEBTOR AMOUNT TO WHOM CEDED

1……………………….. ……………. …………………….

2……………………….. ……………. …………………….

3……………………….. ……………. …………………….

4……………………….. ……………. …………………….

5……………………….. ……………. …………………….

IF THE APPLICANT IS A SURETY FOR ANY AGREEMENT PLEASE COMPLETE

AGREEMENT TYPE AMOUNT IN FAVOUR OF

1……………………… …………… ……………………..

2……………………… …………… ……………………..

3……………………… …………… ……………………..

4……………………… …………… ……………………..

5……………………… …………… ……………………..

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WHAT TYPE OF FACILITY DO YOU REQUIRE?

1.Deferral of payment for products

and services provided by the

Credit Provider? …….or

2. Installment sale? ……..or

3. Rent to own?………

We agree that

(A). All goods are supplied subject to the terms and conditions set out hereunder and on the

reverse side of every invoice or delivery note,

(B). I/We the undersigned am/are duly authorised to represent the Consumer and to bind the

Consumer to this agreement. A copy of the Power of Attorney authorising me/us is attached.

TERMS AND CONDITIONS

3. IN THIS AGREEMENT

"The Act": means the National Credit Act (Act 34 of 2005) including Schedules to the Act,

regulations made or notices published in the Government Gazette.

"Arrears": when referring to an amount outstanding on the account of the Consumer, means

the amount that should already have been paid.

"Assessment": means the complete creditworthiness assessment done by the credit provider as

determined by the Act.

"Collection Costs": are costs incurred by the credit provider in enforcing payment of the

Consumer's account, including collection costs charged by an Attorney on an attorney

and client scale, as well as collection fees paid . to any third party for the recovery of

the outstanding debt, based on the maximum costs determined by the Supreme Court

Act of 1959, the Magistrate's Court Act or 1944, the Attorneys Act of 1979 and the

Debt Collectors Act of 1998.

"Consumer": means the customer.

Irrespective of the legal status of the customer, whether the customer is a natural

person, a Company, a Close Corporation, a Trust or a Partnership, "consumer" shall

refer to the customer.

"Credit Bureau": means an information bureau registered as such in terms of the Act, as well as

the National Credit Register.

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"Credit Limit": means the amount that the Consumer and the Credit Provide have agreed shall be

the maximum amount on standard terms that the outstanding account shall be allowed

to reach.

"Credit Provider": means BRIEKDRAAI BELEGGINGS (PTY) LTD T/A PONGOLA COLD

STORAGE.

"Default charges": means all the charges that may be levied against an account which is in default

in terms of the Act and to which the consumer has agreed in this contract. These

charges include interest, default administration charges and collection fees,

"Domicilium Citandi et Executandi": means the physical address of the Consumer, at which

legal notices will be delivered and be accepted by the Consumer.

"Financial Information": means the latest audited financial accounts of the Consumer as well as

the latest management accounts and cash-flow forecast of the Consumer.

"Interest": means the maximum rate of interest that may be charged in terms of Section 103 and

Regulation 42 of the Act.

"Outstanding Amount": when referring to the account of the Consumer, means the total amount on

the account, irrespective of the age of the debt.

"Person": shall mean any person, whether a natural person of a legal entity.

"Power of Attorney": means an extract from the minutes of a meeting of the Board of Directors or

the Members of a Consumer, authorising a specific person to represent the Consumer

and to sign documents on behalf of the Consumer.

"Prescribed Form": refers to any form prescribed by the Act which has to be completed by either

the credit provider or the consumer.

"the goods" means any product provided and/or services rendered by any division, branch or

affiliate of the Credit Provider, indicated on any company forms, price lists, quotations,

delivery notes, orders and invoices.

4. PRICE

4.1 The price of the goods shall be the usual price applicable at the time of the dispatch of the

goods;

4.2 The Credit Provider's price lists shall be considered merely as a guide to the Consumer and the

Credit Provider has the right, from time to time, for any reason and without notice to the

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Consumer, to change the prices of any of its goods, whether such prices are reflected on price

lists or not.

5. PAYMENT

5.1 Payment must be made according to the payment terms contained in this application form,

which shall be the contract between the Credit Provider and the Consumer once signed by

both parties, and of which the Consumer shall receive on approval of any credit facility by the

Credit Provider;

5.2 Should the Consumer fail to make payment timeously or withhold payment or any portion

thereof for any reason whatsoever, the Credit Provider shall be entitled to withdraw or reverse

any agreed discount or rebate, and claim immediate payment of all amounts owing, or

alternatively, at the Credit Provider's sole discretion, to set off the amount of such discount or

rebate against any rebate or other credits or allowances or payments due to the Consumer;

5.3 The Consumer shall not claim the right to rebates and/or discounts on any basis of whatsoever

nature unless a Manager or Director of the Credit Provider shall have agreed to such rebates

and/or discounts in writing, and further provided always that such amount shall not be allowed

on any goods dispatched if payment for any goods whatsoever involved prior thereto is

overdue;

5.4 In all cases where the Consumer uses a postal, banking, electronic or similar method or

service to effect payment, the supplier of such method or service shall be deemed to be the

agent of the Consumer;

5.5 The Consumer shall not be entitled to claim set off or deduction in respect of any payment

due by the Consumer to the Credit Provider for goods delivered or services rendered and the

Consumer will not be entitled to stay any action . instituted by the Credit Provider pending

the adjudication of any counter claim of the Consumer;

5.6 Should any amount not be paid by the Consumer on due date the whole amount in respect of

all purchases by the Consumer shall immediately become due, owing and payable

irrespective of the dates on which the goods were purchased. The Consumer agrees that

interest at the maximum rate determined in terms of section 103 of the Act and prescribed by

the Minister from time to time, shall be charged on all amounts that are not paid on due date;

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5.7 The Credit Provider shall have the right to suspend all services until all amounts due and

payable by the Consumer are paid in full.

6. CREDIT FACILITIES

6.1 The Credit Provider reserves the right to withdraw any credit facilities at any time without

prior notice and the nature and extent of such facilities shall at all times be at the Credit

Provider's sole discretion.

6.2 For the purpose of opening this credit account and the establishment of the requested credit

limit, the Consumer hereby authorizes the Credit Provider to do a complete and extensive

creditworthiness assessment of the Consumer, as required by the Act. Such assessment shall

include enquiries with all Credit Bureau and the National Credit register.

6.3 Should the Consumer require an increase in the agreed credit limit, a written request must be

submitted to the Credit Provider together with authorization for the Credit Provider to do a

complete assessment of the Consumer's ability to service the new increased credit limit in

terms of section 119 of the Act.

6.4 The Consumer may, at any stage after entering into the contract of credit with the Credit

Provider, request a temporary increase in the credit limit to accommodate a particular

transaction or specified occurrence, on condition that the request is in writing and that the

Credit Provider is given authority to do a complete assessment of the creditworthiness of the

Consumer. It is explicitly agreed that the credit limit so increased will revert back to the

original agreed credit limit immediately after the specified occurrence has taken place.

6.5 In the event that an assessment mentioned in any one of the paragraphs above proves that the

Consumer is not capable of servicing the credit limit which has been applied for, the Credit

Provider reserves the right to offer the Consumer a reduced credit limit.

6.6 Should the Consumer require a decrease in the agreed credit limit, a written request must be

submitted to the Credit Provider. Such decrease shall become effective 30 business days after

the receipt of the written request by the Credit Provider. In the event that the balance

outstanding on the account after the implementation of the new decreased credit limit exceeds

the new credit limit, the amount in excess shall not be determined as reckless credit, in terms

section 118(4) of the Act.

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7. ORDERS

7.1 Orders by the Consumer for the Credit Provider's goods shall be made in writing to such

address as may be nominated by the Credit Provider from time to time;

7.2 Oral orders shall similarly be capable of acceptance by the Credit Provider, but the Credit

Provider will not be responsible for any errors or misunderstandings occasioned by the

Consumer's failure to submit orders in writing;

7.3 Orders shall constitute irrevocable offers to purchase the goods in question and shall be

capable of acceptance by the Credit Provider by the delivery of the goods or by the written

acceptance or confirmation of the order;

7.4 In the event of a negotiated deal or quotation for the price and volume of goods and services,

the period for acceptance of the negotiated deal or quotation will be the period as stated on the

quotation. The price per the quotation will, on acceptance of the consumers order, apply in

respect of sales and services. In the event of the quotation not specifying the aforementioned

periods

7.4.1 the quotation is open for acceptance for a period of three (3) days calculated from the date of

the quotation;

7.4.2 the price will, on acceptance, only apply in respect of sales and services for a period of thirty

(30) days calculated from the date of acceptance or as stipulated in the agreement.

7.4.3 Any price quoted by the Credit Provider is subject to a minimum purchase stated in the

quotation.

8. DELIVERY

8.1 Unless otherwise agreed, the Consumer is liable for any transport costs of goods from the

premises of the Credit Provider to any delivery addresses of the Consumer;

8.2 In the event that the Credit Provider transports the goods to the Consumer, delivery and

passing of the risk in the goods shall be deemed to have taken place when the goods are off-

loaded at the Consumer's premises. The signature of any employee of the Consumer on a

Credit Provider's delivery note or invoice shall be prima facie proof of proper delivery;

8.3 In all cases where delivery to the Consumer occurs by carrier, the carrier shall be the

Consumer's agent, and delivery to such carrier by the Credit Provider shall be deemed to be

delivery to the Consumer. The signature of any employee of the carrier shall be prima facie

proof of proper delivery to the Consumer,

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8.4 Should the Credit Provider, at the Consumer's request, agree to engage a carrier to transport

goods to the Consumer, such carrier shall be the Consumer's agent and the Credit Provider

shall engage the carrier on such terms and conditions as it deems fit and the Consumer

indemnifies the Credit Provider against all demands and claims which may be made against it

by the carrier so engaged and all liability which the Credit Provider may incur;

8.5 Delivery of goods to any delivery address given by the Consumer shall constitute proper

delivery of the goods, despite the fact that such address may not have been the address or

premises of the Consumer,

8.6 Whilst every effort will be made to dispatch goods as advised, the Credit Provider does not

guarantee dispatch on any specific date and shall not be liable for any damages for failure to

effect delivery/dispatch timeously for any reason beyond the Credit Provider's reasonable

control, including but not limited to, inability to secure transport, labour, power, materials,

equipment or supplies or by reason, due to so called "acts of God", war, civil unrest, riots,

state of emergency, strikes, exclusion and or any other labour dispute, fire, floods, drought or

legislation;

8.7 In the event that the Credit Provider makes delivery to the Consumer in installments, each

installment shall be deemed to be the subject of a separate contract and non-delivery or delay

in delivery of any installment shall not affect the balance of the contract or entitle the

Consumer to cancel the contract;

8.8 Should the parties agree that part deliveries may take place, then when goods are delivered in

part, invoices relating to separate deliveries shall be paid as if such goods were the subject of a

separate order and no payment shall be postponed until such time as all the goods ordered

have been delivered;

8.9 If the Consumer fails to take delivery of the goods ordered, or in any way delays the

delivery of goods ordered, then the risk in the goods shall immediately pass to the

Consumer and the Consumer shall be liable to pay the Credit Provider the reasonable costs

of storing, insuring, and handling the goods, until delivery takes place;

8.10 The Consumer shall be barred from lodging any claim in respect of discrepancies between

goods charged and goods delivered, unless the Consumer has specified on the delivery note

the nature of the discrepancy when taking delivery.

9. OWNERSHIP & RISK

9.1 The Consumer shall fully insure the goods purchased from the Credit Provider against loss

or damage, until the full price has been paid by the Consumer for such goods. Pending

payment to the Credit Provider for goods purchased, all benefits in terms of the insurance

policy relating to the insurance of such goods are ceded to the Credit Provider;

9.2 The Consumer will ensure that the Landlord of the building rented by the Consumer waives

its rights of hypothec on all goods supplied to the Consumer by the Credit Provider. The

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Consumer is obliged to supply the Credit Provider with a copy of the written waiver of the

Landlord's Hypothec.

9.3 The Credit Provider has the right to pack goods into returnable containers and these crates

remain the property of the Credit Provider.

10. LEGAL PROCEEDINGS

10.1 Regardless of the place of execution or performance in terms of this agreement, these terms

and conditions and all modifications and amendments hereof, shall be governed by and

decided upon and construed in accordance with the laws of the Republic of South Africa;

10.2 Either party to the contract between the Consumer and the Credit Provider, shall at its

election be entitled to bring any action or proceedings to enforce its rights in terms of the

contract, in the Magistrate's Court, notwithstanding that any such action or proceedings may

otherwise have been beyond the Jurisdiction of such Court, for which purposes this clause

shall constitute the consent contemplated in section 45 of the Magistrate's Court Act (No.

32 of 1944) or any statutory modifications or re-enactments thereof for the time being in

force

10.3 The Consumer shall pay all legal costs, including attorney/own client costs, tracing

agent's fees and collection charges which the Credit Provider may incur intaking any steps

pursuant to any breach of these terms and conditions by the Consumer;

10.4 The Consumer agrees that any payments made on an account shall in the first instance be

offset against accrued interest charges, thereafter against collection fees and legal fees, and

finally against the deferred capital balance on the account.

10.5 The Consumer's physical address as given in this document, shall be recognized as the

Consumer's domicilium citandi et executandi for all purposes in terms of this agreement,

whether in respect of the serving of any court process, notices, the payment of any amount

or communications of whatever nature;

10.6 In terms of the Act, unless the Consumer objects to the correctness of any entry on any

statement, delivery note or invoice in writing within five (5) business days before the due

date of payment of such statement, delivery note or invoice, it will be deemed that the

Consumer accepts that the entries are correct and he does not dispute such entries;

10.7 It will not be necessary for the Credit Provider to prove that the documents referred to in

clause 10.6 were received by the Consumer. In the event of the Consumer not receiving any

of the documents referred to in clause 10.6, the Consumer must timeously acquire a

duplicate from the Credit Provider, failing which it will be accepted that the set documents

were received by the Consumer.

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11. ARBITRATION

11.1 The Credit Provider has the sole option to refer any dispute arising from or in connection

with this agreement to a Dispute Resolution Agent or to a Debt Counselor for arbitration,

which arbitration shall bind both the Credit Provider and the Consumer;

12. NEGOTIABLE INSTRUMENTS

12.1 Acceptance of a negotiable instrument by the Credit Provider shall not be deemed to be a

waiver of the Credit Provider's rights under this agreement regarding cheques/bills furnished

by the Consumer to the Credit Provider. The Consumer waives his right to insist on notice

of dishonor or protest given to it in the event that the cheque/bill is dishonored.

13. WARRANTIES & INDEMNITY

13.1 The Consumer agrees that the Credit Provider shall not, under any circumstances

whatsoever, be held responsible for any consequential damages suffered by the Consumer in

the use of the product/s supplied by the Credit Provider.

13.2 Notice of any claim by the Consumer in respect of defective and/or spoiled goods must be

received by the Company in writing not later than 24 hours after delivery of the goods to the

place of delivery, failing which such claim by the Consumer shall be deemed to be waived

and absolutely barred.

13.3 In the event of the Consumer mixing any products of the Credit Provider with any other

product not manufactured or supplied by the Credit Provider and such product being applied

or used by the Consumer were to be faulty or sub-standard, the Credit Provider will not be

liable for any loss or damage sustained by the Consumer as a consequence of the applying or

using of such product.

14. GENERAL

14.1 This contract represents the entire agreement between the Credit Provider and the Consumer

and shall govern all future contractual relationships between the Credit Provider and the

Consumer and shall also be applicable to all debts which the Consumer may owe to the

Credit Provider prior to the Consumer's signature hereto;

14.2 No amendment and/or alteration and/or variation and/or deletion and/or addition and/or

cancellation of these terms and conditions, whether consensual or unilateral or bilateral shall

be of any force and effect unless presented in writing and signed by a director of the duly

authorized representatives of the Credit Provider and the Consumer. No agreement, whether

consensual or unilateral or bilateral, purporting to obligate the Credit Provider to sign a

written agreement to amend, alter, vary, delete, add or cancel these terms and conditions

shall be of any force and effect unless presented in writing and signed by an authorized

Manager or Director of the Credit Provider;

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14.3 No relaxation or indulgence which the Credit Provider may give at any time in regard to the

carrying out of the Consumer's obligations in terms of any contract shall prejudice or be

deemed to be a waiver of any of the Credit Provider's rights in terms of any contract;

14.4 The Consumer shall not cede its right nor assign its obligation;

14.5 The Credit Provider may at any time in its sole discretion cede or assign all or any of its

rights in terms of this application for credit facilities including all terms and conditions to

any third party without prior notice to the Consumer;

14.6 Any written notice to the Credit Provider shall be addressed to the relevant Divisional

office;

14.7 The Consumer undertakes to notify the Credit Provider within a period of seven days of any

change of address or any changes in the information as set out in this agreement;

14.8 The headings in this document are included for convenience and are not to be taken into

account for the purpose of interpreting this agreement;

14.9 I/We, the undersigned, do hereby warrant that all the information recorded in this

application is true and correct and I/we agree that all transactions concluded with the Credit

Provider shall be subject to the terms and conditions specified herein and agree to be bound

by all such terms and conditions, and without limiting the generality of the afore going,

especially clause 15 of this document (Deed of Suretyship), in so far as the latter relates to

the signatories. I/We further confirm that I/we have read, understood and agreed to all the

provisions contained in this credit application form and warrant that the information

supplied is true and correct and undertake to notify the Credit Provider immediately in

writing of any change in ownership or details contained herein and accept herewith liability

for all debts incurred by the Consumer,

14.10 Without derogating from the generality of the foregoing, should any of the information

furnished herein be inaccurate and the Credit Provider suffer damages in consequence

thereof, I/we agree that without prejudice to the Credit Provider's other rights at law, the

said damages shall be deemed to be equal to the balance outstanding due to the Credit

Provider in respect of goods sold and delivered by the Credit Provider pursuant to this

credit application.

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14.11 Should the Consumer

14.11.1 fail to comply with any term or condition of this agreement; and/or

14.11.2 be sequestrated, liquidated or placed under judicial management; and/or

14.11.3 enter into a settlement or negotiation with creditors; and/or

14.1 L4 allow the granting of a judgment; and/or

14.11.5 fail to comply with such judgment within 7 (seven) days; and/or

14.11.6 commit or allow any act that may endanger or prejudice the rights of the

Credit Provider,

the Credit Provider will immediately be entitled to claim payment of the total amount, plus

interest and costs payable by the Consumer in terms of this agreement.

15. DEED OF SURETYSHIP

15.1 I/We, by my/our signature to this contract, in addition to the above and terms and conditions

hereunder, hereby bind myself/ourselves in my/our personal capacity as surety for and co-

principal debtor in solidum with the Consumer in favour of the Credit Provider for the due

performance of any obligation of the Consumer and for the payment to the Credit Provider by

the Consumer of any amounts which may now or at any time become owing to the Credit

Provider by the Consumer from whatsoever cause arising and including, but without limiting the

generality of the foregoing, any claims for damages and actions against the Consumer acquired

by way of cession. This suretyship shall be a continuing covering guarantee surety which may

only be cancelled in writing by the Credit Provider and then only, in the event that all sums then

owing by the Consumer (whether due or not) to the Credit Provider have been paid in full. I/We

hereby renounce the benefits of the legal exceptions (benefit of Excussion and Division) and the

session of Action, with the force, meaning and effect with which I/we declare myself/ourselves

to be fully acquainted. I/We furthermore bind myself/ourselves irrevocably to all the terms and

conditions set out in this application;

15.2 In the event of the Credit Provider having to institute action against me/us, I/we undertake to pay

the costs thereof on the scale as between attorney and own client including collection,

commission and tracing fees.

15.3 I/We warrant that the directors/partners/members/sole proprietor/trustees/sureties have never

been insolvent or associated with any business failure.

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15.4 I/We having read and understood the terms and conditions of this agreement as set out

hereunder, accept and agree that same will be binding to all transactions concluded between the

Credit Provider and the Consumer.

15.5 I/We choose domicilium citandi et executandi (physical address for the service and execution of

legal or any other notices) as specified in Paragraph 2 of this document.

15.6 That any purported deletion, alteration or amendment of the provisions and/or terms and

conditions of this credit application form by myself/ourselves and/or the Consumer shall be of

no force and effect and such provisions and/or terms and conditions purportedly deleted, altered

or amended shall remain in full force and effect, unless such deletion, alteration or amendment is

agreed to in writing by a duly authorized Manager or Director of the Credit Provider and the

Consumer.

This surety is signed by: 1 ............................................................................... (Full name)

Identity Number: .....................................................................

Signature: .................................................................................

Date of Signature: ....................................................................

2…………………………………………………… (Full name)

Identity Number: .....................................................................

Signature: .................................................................................

Date of Signature: ....................................................................

16. NATIONAL CREDIT ACT

The Consumer understands that the information given herein is to be used by the Creditor for the

purposes of assessing his credit worthiness;

The Credit Provider has the Consumer’s consent at all time to contact and request information

from any persons, credit bureaus or businesses, including those mentioned in this Application and to

obtain any information relevant to the Consumer’s credit assessment including, but not limited to,

information regarding the amounts purchased from the supplier’s per month, length of time Credit

Provider has dealt with such supplier, type of goods or services purchased and manner and time of

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payment;

The Consumer agrees that information given in confidence to the Credit Provider by a third party

in respect of the Consumer will not be disclosed to the Consumer;

The Consumer hereby consents to and authorizes the Credit Provider at all times to furnish

personal personal and credit information concerning the Consumer’s dealings with the Credit

Provider to a credit bureau and to any third party seeking a trade reference regarding the Consumer in

his dealings with the Credit Provider;

Should the Applicant’s application be refused, the Applicant may request in writing reasons for

the refusal of the application

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16. SIGNATURES

This application form, if signed by the Consumer and the Credit Provider, shall form the credit

contract between the two parties and shall remain in full force and effect until cancelled by one of

the parties giving the other 20 business days' written notice of cancellation. Such cancellation

shall not in any way waiver the rights of the parties hereto until the full amounts owing to the

Credit Provider have been paid in full.

SIGNED at _______________________this_______day of_____________________20___

Witnesses

1.___________________ ______________________________________

For and on behalf of the Consumer being duly authorized thereto

2.___________________

This application for credit is accepted by the Credit Provider and is signed on behalf of the

Credit Provider:

SIGNED at _______________________this_______day of_____________________20___

___________________________________(signature)

___________________________________(full name)