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  • Partner Program

    Partner Program

      Business Details
     
    Please choose:     Channel Partner   Affiliate Partner*
     
    Trading name of business  *
    Registered name of business   *
    Business Reg. No. of Incorporation   *
    VAT Registration number   *
    Date of establishment of business   *
    * Please complete
     
     
      Business Activities
     
    Contacts person's name  *
    E-Mail   *
     
      Postal address same as Physical
    Physical Address   *
    Postal Address   *
    Area Code   *
    Area Code   *
     
    Tel Area code and no.   *
    Fax Area code and no.   *
    Cell no.   *
    * Please complete
     
     
      DETAILS OF : Proprietors / Directors / Members / Partners
     
    Full Name:  *
    ID No. (or date of birth)  *
    Residential Address   *
    Area Code  
     
    Full Name (2nd):  *
    ID No. (or date of birth)  *
    Residential Address   *
    Area Code  
    * Please complete
     
     Bank Account Details
     
    Bank :
    Account Name
    * IE: J Smith
    Branch
    Account No *
    Branch Code *
    Account Type
    * Please complete
     
     Trade References
     
    Company Name:  *
    Tel Area code and no.  *
    Physical Address  *
    Area Code  
     
    Company Name (2nd):  *
    Tel Area code and no.  *
    Physical Address  *
    Area Code  
    * Please complete
     
     
     Please select which products/services you wish to resell:
    Hosting
    Linux Web hosting
    Windows Web hosting
    Virtual Servers
    Colocation
    Dedicated Servers
    RSAWEB Online Backup
    Zimbra
    Connectivity:
    Business ADSL
    Super/Ultra/Premium DSL
    HSDPA
    iBurst


     
     Confirmation


    * The undersigned confirms that : 1.)The accuracy of the information is true and correct. 2.) They are duly authorised to enter into agreements for/on behalf of the applicant. 3.) They have read and understood the terms and conditions of trade and accept them as binding on behalf of the applicant.
     

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