C.O.D Application Form

Registered Company Name *

Trading Name *

Business Type: *

CC
(Pty) Ltd
Sole Proprietor / Partnership
Private

Business Registration Number *

Web Site Address: (If available)

VAT Number:

(Please email a copy of your VAT Certificate if applicable)

Postal Address:

Main Place of Business:

Delivery Address (if different from the main place of business):

Mobile Number: *

Landline Telephone Number:

Fax Number:

E-mail Address: *

Full name of person responsible for placing orders: *

Telephone Number: *

E-mail Address: *

Full name of person responsible for paying the account: *

Telephone Number: *

E-mail Address: *

TERMS & CONDITIONS

I/We warrant that the information contained herein is true and correct in every respect. I/We undertake to notify the Supplier in writing immediately of any change in this information. I/We am duly authorised to sign this Application. I/We acknowledge that I/We have read and understood the Delivery Charge Terms attached hereto and agree that such Delivery Charge Terms shall be binding upon me/us/the company/the close corporation in respect of all transactions entered into between myself/ourselves and the Supplier.

OTP Email Address: *

**PLEASE TAKE NOTE**

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COD Application Form

C.O.D Application Form

C.O.D Application Form

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