Service Provider Membership Registration Form

Legal Entity Info

Registered Name *

Trading Name *

CIPC Number

VAT Number

Contact Persons

Add at least one contact and select one Main Contact and one Finance Contact. The same person may be both the Main Contact and the Finance Contact.

Contact

Contact Name *

Role / Job Description *

Mobile Number *

Office Telephone Number

Email Address *

Main Contact

Finance Contact

CASA Information

Applicant Type *

Service Type *

Business Size *

Industry Involvement *

Head Office Info

Address

Unit / Office

Building / Complex

Street Number and Name *

Suburb *

City *

Province *

Postal Code *