CustomerRegistrationForm

Please assist us by filling in the below registration form. Note that all fields marked with * are mandatory

Sales Representative:	If you are currently dealing with a representative at Promo One, Please type their name above.
Company: *
First Name: *
Surname: *
Title / Position:
Switchboard Number:
Direct Phone Number: *
Cellphone Number:
Email Address: *
VAT number:
Website URL:
Delivery Address 1: *
Delivery Address 2:
Delivery Address City: *
Delivery Address Province: *
Delivery Address Postal Code: *
Delivery Address Country: *

HEAD OFFICE:

Johannesburg

Tel: (087) 820 8282

BRANCHES:

Cape Town: (087) 820 8282
Namibia: 00 264 812 334 135
Durban: (087) 820 8282

PHYSICAL ADDRESS:

Unit 3 Cnr of Kentmere Street &
Heaton Lane,
Longlake Ext.19
Johannesburg, South Africa
1609

MEMBER OF IGC GROUP

Name & Surname	Print Name	Colour Trim	Gender	Employee Number