New Client Registration Form

Company Details:
Company Name / Store Name (Trading name)

Registered Company Name

Company Registration

VAT Registration No

Website

Details of person Responsible for placing order:
First name

Lastname

ID Number

Your Email Address

Landline Phone Number

Cellphone Number

Fax Number

Physical Address:
Street

City

Province
---Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorthern CapeNorth WestWestern Cape
Postcode

Is your postal address the same as your physical address?
YesNo

Payment Details:
Please indicate method of Payment
EFTCashBank DepositSnapscan

Is another person responsible for your accounts?
NoYes

Terms and Conditions of Service

• All work carried out by Bevwiz Dispensing will be subject to the following provisions
• I/We agree that the information that I/We have given is true and correct and that I/We are duly authorised to have provided it.
• I/We agree that all documentation to be provided to me/us may be sent by e-mail to the addresses set out in this Customer Information Form.
• I/We agree that this Customer Information Form is not an application for credit.
• I/We agree that all person(s) that place orders for Goods or Services with Bevwiz on my/our behalf are duly authorised by me/us to do so.
• A 50% deposit is required on acceptance of all quotations and the balance is payable on completion of the job.
• Goods remain the property of Bevwiz until paid in full, Bevwiz reserve the right to remove any parts or equipment if payment is not received within the agreed terms.
• Please note should Invoice not be paid by stipulated date we will reserve the right to hand the account over for collection. All legal costs incurred will be for your account.



I/We have read and agree to the T&C's above