Credit Application

Full name of business*
Owner / Directors
VAT Number
Telephone Number*
Buyer's Name
Buyer's Email*
Account's Name*
Account's Email for invoices and statements*
Trade Reference 1*
Contact person and Telephone number*
Trade Reference 2
Contact Person and Telephone Number
Delivery Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Opening Order
Please indicate how many cases (bottles of 6) you would like to order on credit.
Chenin Blanc
Rijk's Touch Chenin Blanc
Rijk's Private Cellar Chenin Blanc
Rijk's Reserve Chenin Blanc
Rijk's Governor's Reserve Chenin Blanc
Pinotage
Rijk's Touch Pinotage
Rijk's Private Cellar Pinotage
Rijk's Governor's Reserve Pinotage
Rijk's Reserve Pinotage
CAPTCHA

Opening Order