Credit Account Application Form

Credit Account Application

Company Name & Contact Details:

Business Type:(required)

Physical Address / Business Address

Postal Address (If not the same as the above)

Delivery Address (if different from Physical / Business Address)

Contact Details

Type of Company(required)

Details of Directors / Owners / Members

Domicillium citandi et executandi: (Physical address for service of all legal documentation & correspondence)

Bank Details:

Does the total assets of the business or the annual turnover exceed R 2 000 000.00?(required)

Trade References:

Please supply 3 references, ONLY one of which may be a Pharmaceutical Wholesaler, if a Non-Pharmaceutical Company or Pharmacy, 3 suppliers references where purchases are more than R10 000 per month:

Trade Reference 1:

Trade Reference 2:

Trade Reference 3:


Are the premises owned by the Shareholders / Directors?(required)

If no, please provide the following information:

Auditors Details:

Please tick where applicable below:

Has the entity issued or signed any guarantees in favour of other creditors?(required)

Have the Directors / Members issued or signed any guarantees in favour of other creditors?(required)

Have the principals ever been directors/members of a business that was liquidated or underwent business rescue?(required)

Has the Customer's debtor book, or any specific debtor been ceded?(required)

Please email the following documents to along with the submission of this application:

  • Certificate of Incorporation
  • VAT Registration Certificate
  • Copy of Director/s Identification
  • Proof of Business Address (Utility Bill / Lease Agreement – not older than 3 months)
  • B-BBEE Certificate
  • Signed Suretyship (Attached to the email)

Terms & Conditions:

  1. I/We warrant that the information contained herein is true and correct in every respect.
  2. I/We undertake to notify the Supplier in writing immediately of any change in this information.
  3. I/We am duly authorized to sign this application. I/We acknowledge that I/We have read and understood the terms and conditions attached hereto and agree that such terms and conditions shall be binding upon me/us/the company/close Corporation in respect of all transactions entered into between myself/ourselves and the Supplier.
  4. I/We agreed that the Supplier may use the services and records of a registered credit bureau and other suppliers for information required in the initial and future assessment of credit facilities.
  5. I/We agree that the Supplier may disclose information regarding the applicant’s credit worthiness and conduct of the account to any registered credit bureau.
  6. I/We agreed to an ITC check in order to validate credit worthiness. If the Customer does not agree to an ITC check, the Supplier will be unable to open an account and will revert to a COD Customer / any form of account being opened

Please Note:

  • ONLY EFT payments accepted.
  • Once your 30-Day Account application has been credit vetted and approved,  you will receive an email with your account details, our Delivery Charges Document (Please see minimum order value for free delivery) and the Reitzer Healthcare Price List. In the case where more information is required our staff will contact you.
  • The minimum order value means the total value of the order after discount (if any) and excluding VAT.
  • Deliveries take place within 5-7 days provided we have the relevant stock on hand.
  • Accounts run from the 26th to the 25th of the following month. Payments must be received by the 25th of the month. Should the 25th fall on a Saturday, Sunday or Public Holiday then payment must be made by the preceding Business Day.
  • The Supplier shall at its discretion give a settlement discount equivalent to 2.5% on accounts paid within the 30 (thirty) day period and by the dates referred to above.

Click on the link below to read our Terms & Conditions.

* Means Required

I/We acknowledge that by virtue of this application submission that I/we have read and agreed to bind itself, its shareholders, directors, employees, agents to strict compliance with all the terms and conditions of trading.