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Purchase Order Finance
Refer Earn Program
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Referral Form
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*
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3
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Your Details
Name
*
First
Last
Email
*
Phone
*
Company Name (If Applicable)
Required Documents
Upload CK / CIPC Document
*
Drop files here or
Select files
Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 32 MB.
Upload Certified Copy of ID
Drop files here or
Select files
Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 32 MB.
Upload Proof of Bank Account
*
Drop files here or
Select files
Accepted file types: pdf, jpg, png, doc, docx, Max. file size: 32 MB.
These documents are required for REP verification and commission payout processing.
Referral Details
Name of Business You Are Referring
*
Contact Person at Referring Business
*
First
Last
Email Address of Referring Business
*
Contact Number of Referring Business
*
Government Department They Supply To
*
Estimated Funding Amount
*
R100 000 – R250 000
R250 000 – R500 000
R500 000 – R1 000 000
R1 000 000+
Consent
*
I agree to the privacy policy.
Consent
*
I confirm that the business I am referring supplies goods or services to a government department.
Consent
*
I understand that commission is payable only on approved and funded government purchase order deals under the Refer Earn Program (REP).
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Purchase Order Finance
Refer Earn Program
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