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Prushka Customers Credit Application

On completion of this request, you will be immediately emailed the free Prushka Credit Application Form. It is in Word Format so you may easily alter it to suit your business. All you need to do is attach your logo or type in your business name and you are ready to go.

All fields marked with * must be completed.

Title:* Mr Mrs Miss Ms Dr
Contact Name:*
Business Type:*
(There are different forms for different business types.)
Contact Number:
Note: Leave no spaces (e.g. 98745000)
Nature of your business:*

Please type what you see: