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* Indicates required question
Email
*
Your email
Name & Surname
*
Your answer
Contact Number
*
Your answer
Gender
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Male
Female
Age Group
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18 - 35
36 - 50
51 - 70
70 and bove
Brief Business Description And Business Registration Number if Registered.
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Your answer
Business Location
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Your answer
VAT Registration Number
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Your answer
Does your business have a Tax Clearance Certificate / Tax Clearance Pin?
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Yes
No
Business Tier
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Tier 1 - Manufacturer
Tier 2 - Master distributor
Tier 3 - Wholesaler
Tier 4 - Retailer
Other:
Industry
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Building Material
Construction Equipment
Distributors for Locomotive and Power Generation
Electrical Parts and Consumables
Food and Groceries
Medical Consumables and Equipment
Mining Equipment
Personal Hygiene Products
Petrochemicals
Specialized Electrical and Mechanical Parts Manufacturer
Stationary and Textbook Manufacturers
Vehicle Parts
Other:
Years In Business
*
Your answer
Black Youth Ownership % in your business
*
Your answer
Black People With Disabilities Ownership % in your business
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Your answer
How many people does your business employ?
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Your answer
Please provide annual revenue threshold of your business
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R50,000 - R200,000
R201,000 - R500,000
R501,000 - R1m
R1M - R1,5M
R1,501 000 - R3M
R3M and above
Client Reference #1 _Business Name
*
Your answer
Client Reference #1 _Contact Person
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Your answer
Client Reference #1_ Contact Number
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Your answer
Client Reference #1 _E-mail Address
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Your answer
Client Reference #2 _Business Name
*
Your answer
Client Reference #2_Contact Person
*
Your answer
Client Reference #2 - Position in the organization
*
Your answer
Client Reference #2 _Contact Number
*
Your answer
Client Reference #2 _E-mail
*
Your answer
Client Reference #3 _Business Name
*
Your answer
Client Reference #3_Contact Person
*
Your answer
Client Reference #3 - Position in the organization
*
Your answer
Client Reference #3 - Contact Number
*
Your answer
Client Reference #3_E-mail Adress
*
Your answer
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