Financing for Grocery Store Owners
*For existing Grocery stores that want to access credit for their customers
Name of Store Owner:
Email Address:
Your WhatsApp Number:
Residential Address
Age:
--Choose--
20 - 25 Years
26 - 33 Years
34 - 40 Years
40 - 50 Years
Above 50 Years
Gender:
--Choose--
Male
Female
Store name
Store Address (including LCDA) If you sell from home, indicate 'home'
Bank Name and Account No(eg xxxx Bank; 0123456789)
Business line
--Select--
Drinks only (eg soft drinks)
Beverages only
Foodstuff only
All types of Halal Foodstuff, Drinks and beverages
How long have you been in the business?
--Select--
below 2 Years
2-5 Years
5-10 Years
Above 10 Years
Number of regular customers at the moment?
--Select--
below 50
50-100
101-200
201-400
401-1000
Above 1000
I acknowledge that Leeds will only give credit facilities to my customers who I approve
--Select--
Yes
No
I will submit a collateral to backup Leeds' credit facility to my customers
--Select--
Yes
No
I promise to unconditionally pay any outstanding debt if any of my approved customers defaults
--Select--
Yes
No
Details of your Referees
Name, Phone Number, Email & Residential Address of a Reputable Referee 1:
Name, Phone Number, Email & Residential Address of a Reputable Referee 2:
Name, Phone Number, Email & Residential Address of a Reputable Referee 3:
Other Relevant Information to aid Approval:
