Username

Email

Password

Representative Name *

Company Reg. No.

Trading Name *

Postal Address

Postal Code

Delivery Address

VAT Reg. No.

Telephone No

Fax No

Bank Name

Branch Name

Account No

Years Under Present OwnerShip

Names & Addresses of Directors/Partner

1. Name and Address

ID Number

Please attach copies of Identity Documents

ID Copy Upload

ID Number

ID Copy Upload

Trade References

Contact Person

Telephone No

Company

Contact Person

Telephone No

Purchase Terms 1) FIRST ORDER MUST BE R15000.00 EXCL. OR MORE. 2) NO GOODS WILL BE DESPATCHED UNTIL PAYMENT IS RECEIVED. 3) ALL PRICES QUOTED ARE EX CLUSIVE OF VAT. 4) ALL WARRANTIES ARE AT R and S TRADERS’ CC’s DISCRETION. 5) INVOICES NOT PAID WITHIN 48 HOURS WILL BE CANCELLED.

Name in Full

Position in Company

Date:

All information provided is true and correct

Registration confirmation will be emailed to you.