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Name
Surname
Cell number
Email address
Gender
Nationality
How did you hear about the Caltex opportunity?
What type of service station are you applying for?
Existing
New
Greenfields
Do you have petroleum retailing experience?
Yes
No
Do you have your own capital available?
Yes
No
Amount available:
% encumbered
% unencumbered
Do you have access to additional funding?
Yes
No
Funding source
Bank finance
Shareholder/partner funding
Development funding
Asset finance
Private investor funding
Other
Please specify
Amount available:
Security/conditions attached:
Yes
No
Please specify
Status:
Approved
Pending
Indicative only
What is your province preference?
Eastern Cape
Free State
Guateng
KwaZulu-Natal
Limpop
Mpumalanga
North West
Northen Cape
Western Cape
Do you intend to trade as a:
Individual
Partnership
Trust
Company
Close Corp
Other
Submit / send etc