Title : Mr Mrs Miss Name : Surname : Designation : Company Name : Telephone No. Fax No Cell No. e-mail address Website (if applicable) Nature of business : How long has your business been trading? What purchasing authority do you have? making a purchase decision influencing a purchase decision no purchasing authority Are you interested in buying our products for : company use personal use catering reselling other (please specify) Other : What would you estimate your monthly purchasing order at : less than R1000-00 R1000-00 - R2000-00 R2000-00 - R5000-00 R5000-00 - R10 000-00 R10 000-00 - R20 000-00 R20 000-00 - R50 000-00 more than R50 000-00 Are you interested in buying : once-off only now & then monthly weekly daily How would best describe your ordering pattern : fixed items with fixed quantities fixed items with varying quantities varying items with fixed quantities varying items with varying quantities How would you like to receive your order? free delivery to your door (conditions apply) delivery by courier (charged separately) collected by yourself Would you like to receive updates/specials/promotions etc. via e-mail? yes no