Credit Application Customer Registration Please download this form, complete it and upload it below Credit Application FormClick here to Download the Credit Application Form Download Register Username * Email address * A password will be sent to your email address. Phone * User Type * Cash Account Customer RegistrationCredit Application Customer Registration Upload an image of your shop *Supported file types: jpg, jpeg, png, txt, pdf, doc, docxDownload and fill the form Fully Filled Credit Application Form Supported file types: jpg, jpeg, png, txt, pdf, doc, docxCompany / Business Name *Address *Postal code *Company Telephone Number *Physical Location *Contact Person 1 - First and Last Name *Designation Copy of ID *Supported file types: jpg, jpeg, png, txt, pdf, doc, docxSelect your Preferred Branch *Head Office - Rafiki Business Park Thika RoadNairobi CBD BranchEldoret BranchNakuru BranchKisii BranchMombasa BranchMeru BranchCopy of Practicing License from Pharmacy and Poisons Board or from any other Regulatory Board *Supported file types: jpg, jpeg, png, txt, pdf, doc, docxCopy of Company Certificate of Incorporation/Partnership Deed/Business Registration Certificate *Supported file types: jpg, jpeg, png, txt, pdf, doc, docxCopy of the National Identity card or Passport for the Directors guarantying the Company *Supported file types: jpg, jpeg, png, txt, pdf, doc, docxCopy of Memorandum and Articles of Association (Page showing the shareholding) or copy of CR12 *Supported file types: jpg, jpeg, png, txt, pdf, doc, docxCopy of KRA PIN certificate *Supported file types: jpg, jpeg, png, txt, pdf, doc, docxYour personal data will be used to support your experience throughout this website, to manage access to your account, and for other purposes described in our privacy policy. Register Back to login
