Section 1: COMPANY/ SUPPLIER DETAILS Legal name of company (required) Trading name of company (required) Income Tax Reference number (required) VAT registration number Company registration number Close corporation registration number Number of full time employees Section 2. CONTACT DETAILS Postal Address of company Physical address of company Business telephone * Mobile phone number Fax Number Website Email Address Toll free number SECTION 3MAIN CONTACT PERSON IN YOUR ORGANISATION Name Job Title Telephone Number Fax Number Email Address SECTION 3 MAIN CONTACT PERSON RESPONSIBLE FOR SALES IN YOUR ORGANISATION Name Job Title Telephone Number Fax Number Email Address Section 4. COMPANY STOCK CLASSIFICATION Beauty spot (PEBS)Beverages & Cereals (PEBC)Biscuits/ Chocolate/ Candy/ Gum (PEBIS)Book shop (PEBK)Condiments (PECOS)Drinks (PED)Frozen foods (PEFF)Mother care (PEMC)Household (PEHS)Spirits & Wimes (PESW)Village market products (PEVM)Others...Other: describe other Section 5. ACCOUNT DETAILS Account Details Branch Account Number Contact Person Phone Number Email Address Section 6. NAMES OF ALL OWNERS, DIRECTORS AND RESPECTIVE DESIGNATIONS Section 7: SUPPLIER GROUPING DETAILS Type of firm: Please tick the relevant Public Company (LTD)Private company (PTY)Close Corporation (cc)Joint VentureConsortiumSole ProprietorForeign CompanyPatnershipTrustSection 21 CompanyGovernment/ ParastatalOther: Specify: Status of enterprise MicroSmallMediumLargeOther: Specify: Declaration of any other conflict of interest: Comments/Notes