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CUSTOMER REGISTRATION FORM

Personal Details

Gender:

Male

Female

First Name:

Last Name:

Date of birth:

ID/Passport Number:

Street Address:

Suburb:

City:

Country:

Postal Code:

Company Details

Business Name:

Partner Type:

Retailer

Wholesaler

Corporate Promotional Buyer

Business Type:

Sole Proprietor

Company (PTY) LTD

Closed corporation

Partnership

Company Registration number:

VAT Registration number:

Business Address:

Delivery Address:

No of years in business:

Upload company registration document:

Upload VAT registration document:

Contact Details

Telephone no:

Mobile no:

Fax no:

Email Address:

Website Address: