Application for Credit Facilities

Submit your account information and supporting documents securely to BioFusion Implant Solutions (Pty) Ltd.

Signature requirement: this online submission captures the application data and evidence, but it does not replace the signature and suretyship formalities in the approved Account Application. For credit facilities, BioFusion must retain the completed signed application before final activation unless an authorised BioFusion representative records a lawful written waiver.

Download BioFusion Account Application v1.1 (PDF)

Leave this field empty

1. Applicant information

Entity type * Registered name * Registration number Trading as VAT registration number Nature of business Year commenced business Email * Telephone * Fax Premises If rented, landlord Customer type Delivery site type Postal address Physical address * Delivery address * Registered address (Company / CC / Trust) Postal code Maximum credit limit requested (R)

2. Accounts, banking and references

Accounts contact person Accounts telephone Accounts email Accounts fax Bank Branch name Branch code Account name Account number

Directors / Members / Partners / Proprietor / Trustees

Full nameID / PassportAddress

Trade references

NameAccount numberTelephoneEmail

3. Product safety and ordering contacts

These contacts help BioFusion route urgent product-safety, recall/FSN and ordering communications to the correct person. They do not replace clinical complaint reporting through the appropriate quality process.

Product safety / recall contact name Mobile / direct telephone Product safety email Authorised ordering personnel Names and email addresses of people authorised to place orders on this account.

4. Supporting documents

Files are stored in BioFusion protected storage rather than the public WordPress Media Library. PDF/JPG/PNG only; maximum 10 MB per file.

ID / passport document(s) Business letterhead Authorising resolution (where applicable) Entity document(s) Select the entity type above to see the expected supporting document. Completed signed Account Application v1.1 Recommended at submission. If omitted, the application can be reviewed but credit activation may remain pending. Other supporting document(s)

5. Declarations and consent

I confirm that the information supplied is true, accurate and complete and that I am authorised to submit it on behalf of the applicant.

I authorise BioFusion to verify information relevant to the credit application with lawful sources, including trade references and credit information sources, as provided for in the Account Application.

I have been given access to BioFusion Account Application v1.1 and understand that this online submission does not itself execute the Deed of Suretyship or replace the required signatures/witnesses.