VOIP : SIP : Skype : Asterisk Phone Distribution in South Africa
2nd Floor, The Avalon building, Cnr. Hope & Mill Streets
Gardens, Cape Town, South Africa.
Tel: (0)21 462 6798
Fax: (0)21 462 6794
C.O.D DEALER APPLICATION FORM
Terms strictly Cash or Internet Transfer
Trading name of business:
Registered name of business:
Business Reg. Number of incorporation:
VAT registration number:
Date of establishment of business:
year:
month:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
day:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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31
Business activities:
Contact person's name:
Contact person's surname:
Email:
Secondary Email:
Physical Address:
Postal Address:
Telphone number:
area code:
tel no:
Fax number:
area code:
fax no:
DETAILS OF: Proprieters/Directors/Members/Partners
Full Name:
ID No. (or date of birth):
Residential Address:
Full Name:
ID No. (or date of birth):
Residential Address:
BANK DETAILS: To verify internet transfers
Bank:
Branch:
Account Name:
Account Type:
Branch Code:
Account Number:
TRADE REFERENCES
Company Name:
Tel No:
area code:
tel no:
Address:
Company Name:
Tel No:
area code:
tel no:
Address:
Please send me Evenflow updates & news:
CONFIRMATION
I confirm that the above information is true and correct. They are duly authorised to enter into agreements for/on behalf of the applicant. They have read and understood the
terms and conditions
of trade and accept them as binding on behalf of the applicant.
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