ISP Account Application Form

Independent Service Provider Account Application Form


Is this a request for the creation of an Independent Service Provider that does not yet exist on the database?
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Previous customer details:

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Category:

Independent Service Provider

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Individual:

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Organisation:

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Contact Person:

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Physical Address:

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Banking Details:

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Collection Authorisation
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Postal Address:

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Originator Details: [For Office Use Only]

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Disclaimer:

  1. I warrant that the information provided herein is to the best of my knowledge true, correct and complete.
  2. I acknowledge that the submission of this form, will not automatically give me access to training and technical information of DTSA and that the application is subject to approval by DTSA.
  3. I agree and understand that any approved application will be subject to the specific terms and conditions of the product/part/information I am intending to purchase/subscribe to.
  4. I hereby consent to a credit check being conducted and consent to any further checks which may be required as determined by DTSA.
  5. I hereby specifically consent to the sharing of my personal information to any DTSA Affiliate and/or Agent where required to fulfill the services.
  6. I further specifically consent to the use of my / the company's Personal Information as provided herein for the purposes of this Agreement in line with POPIA, as well as for the purposes of marketing and Direct Marketing to me by DTSA or its affiliates.
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Mitsubishi FUSO Authorised Distributor
Daimler Truck Southern Africa Ltd.
https://dtsa.daimlertruck.com/

Manufactured by Daimler Truck Southern Africa Ltd.