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Approved Body Repair Centre - Account Application Form


Is this request for the verification of an application to be an Accredited DTSA Body Repair Centre?

If yes, this is a request for the creation of a new customer.

If no, this is a request for the change of existing customer details.

Category Criteria

Individual

Organisation

Individual

Organisation

Contact Person

Physical Address

Banking Details (Complete if category is"Dealer")

Physical Address

Banking Details

Postal Address

Originator Details: [For Office Use Only]

Postal Address

Originator Details

Disclaimer

2) I warrant that the information provided herein is to the best of my knowledge true, correct and complete.

3) I acknowledge that the submission of this form, will not automatically give me access to training and technical information of DTSA and that the application is subject to approval by DTSA.

4) I agree and understand that any approved application will be subject to the specific terms and conditions of the product/part/information I am intending to purchase/subscribe to.

5) I hereby consent to a credit check being conducted and consent to any further checks which may be required as determined by DTSA.

6) I hereby specifically consent to the sharing of my personal information to any DTSA Affiliate and/or Agent where required to fulfill the services.

7) I further specifically consent to the use of my/ the company's Personal Information as provided herein for the purposes of this Agreement in line with POPIA, as well as for the purposes of marketig and Direct Marketing to me by DTSA or its affiliates.

8) I warrant that I am duly authorised to sign this application on behalf of the applicant.

Debtors Manager Authorisation: [For Office Use Only]