B2B Customer Request

1 · Operating provinces *

Gauteng Western Cape KZN Eastern Cape

2 · Company details

Registered name

Trading name *

Registration number

VAT registered

Yes No

Number of shops

3 · Apply for *

Select the payment terms you are applying for. This becomes your account category after approval.

COD Cash on delivery 7 Day Account Account payment 30 Day Account Account payment

4 · Estimated monthly spend *

R1 000 – R5 000 R5 000 – R10 000 R10 000 – R15 000 Above R15 000

5 · Proof of business *

Upload CIPC / bank letter / utility bill / storefront photo

PDF or image preferred. Document should be recent (≤ 3 months where applicable).

6 · Owner / director

Title

First name

Last name

ID / passport number

Owner phone

7 · Residential / business address

Address line 1

Address line 2

City

Province / state

Postal code

Country

8 · Shipping address

Same as residential / business? Yes No

Address line 1

Address line 2

City

Province / state

Postal code

Country

9 · Contact details

Email *

Business phone

Cell phone

10 · Order contact person

Same as owner? Yes No

Title

First name

Last name

Phone

Email

11 · Terms & conditions

Shipping & fulfilment

Orders are shipped Tuesday to Thursday.
Free shipping on orders of R2 500 or more (mainland South Africa, standard courier).
Typical delivery lead time is 1–3 business days after dispatch.
Accounts inactive for 2 months or more may be suspended pending re-activation.

POPI disclaimer

By submitting this application you consent to Raceworxbicyclecomponents Pty Ltd collecting and processing your personal and business information for credit assessment, account administration, order fulfilment, and related legitimate purposes under the Protection of Personal Information Act (POPIA). Information is shared only as required to process your account and orders. You may request access to or correction of your data by contacting us.

I, —, hereby agree to the terms and conditions above.

I accept the terms & conditions *

Yes No

Signatory first name

Signatory last name

Date

Signed at (place)

Digital signature *

Draw your signature below (or provide typed signatory name above as fallback). Clear and resign if needed.

RACEWORX User Section

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