please supply the following contact … · directors: g.r. dunford (managing), c.v amoils, d....
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iro.co.za
A MEMBER OF THE GROUP
Gauteng 9 Landmarks Avenue Kosmosdal Samrand 0157
Tel: +27 12 657 0960
Cape Town Unit 14 Frezzitta Business Park Cnr Koeberg Road & Freedom Way Milnderton Cape Town 7441
Tel: +27 21 555 3207
Durban Unit 3 Thynk Retail Park 23 Riverhorse Road Riverhorse Vally 4017
Tel: +27 31 564 7283
Nelspruit Unit C2 Waterfall Park 55 Rapid Street Riverside Industrial Nelspruit 1200
Tel: +27 13 752 4654
PO Box 4487 The Reeds 0158
086 123 MIRO(6476)
www.miro.co.za
Hudaco Trading Pty Ltd Reg No. 1984/005432/07Directors: G.R. Dunford (Managing), C.V Amoils, D. Naidoo*, N. Mandindi*
(*Independent Non-Executive) Secretary: Hudaco Group Financial Services Pty Ltd
BUSINESS PARTNER REGISTRATION FORMPlease complete this form and Email it back to us at: [email protected]
Alternatively, consider filling out our online application form for your convenience.http://www.miro.co.za/become-a-business-partner/
Registered Name of Business:
Trade Name of Business (if different):
Office Tel. Number: (or cellular): Physical Address:
Company Website URL:
Type of Business (Form of incorporation): Sole Proprietor Partnership Trust CC (Pty) Ltd Ltd
Company Registration Number: VAT Registration Number:
Nature of Business: End User Installer Reseller Internet or Voice Service Provider Other :
PLEASE SUPPLY THE FOLLOWING CONTACT DETAILS
Email address for Quotes & Invoices:
Cell number for SMS payment confirmations:
Primary contact person name: Primary Mobile Number: Primary Email Address:
Accounts Name: Accounts Mobile No: Accounts Email:
Buyer Name: Buyer Mobile No: Buyer Email:
Additional Contacts to receive Product & Marketing Information: Name & Email
Which other trade suppliers are you registered with?
Where did you hear about us? Google MiRO External Sales Internet/Website Magazine Referral Trade Show
Please specify the publication/website/referral/show or other:
I (Full names)____________________________ ID Number ____________________in my capacity as (position)_____________________ of (business names)_____________________________hereby confirm that:
1. The information contained in this document is true and correct,2. I am duly authorised to enter into agreements for/on behalf of the applicant,3. I have read and understood the Miro terms & conditions of trade and accept them as binding upon the applicant,4. I understand that this is a business partner registration only and not a credit application.
Signature __________________________________ Date______________________