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Please complete the sections relevant to your type of business in the form below and click on submit.
1. How long has the business been in operation?
  0 to 1 years
  1 to 2 years
  2 to 3 years
  3 to 4 years
  more than 4 years
2. How does the business operate?
  Business Hours only
  24 Hours
3. Do you have full and comprehensive professional indemnity insurance?
If Yes, name of insurer
           and policy number
4. Have you been approved by an Insurance Company?   Yes       No
5. Have you been approved by a Manufacturer?   Yes       No
6. Do you belong to a Trade Association?   Yes       No
7. Are you VAT registered?   Yes       No

8. Please indicate if any of the following the manufacturers and insurance companies have officially approved you as a contractor or service provider, and if you belong to any trade association. (if so, you will need to provide us with the name and telephone number of the person in that organization who can verify the approval)
(all applicants)
DEFY   Yes      No
AEG   Yes      No
KELVINATOR   Yes      No
OCEAN   Yes      No
Santam   Yes      No
Auto & General   Yes      No
Mutual & Federal   Yes      No
SA Eagle   Yes      No
Outsurance   Yes      No
Hollard   Yes      No
IOPSA   Yes      No
ECASA   Yes      No
MBA   Yes      No
Others (Please specify)
For each organisation that you selected "Yes" for above, please provide
the organisation name, contact person's name and telephone number.

eg. DEFY, John Smith, 076-123-4567
AEG, Nigel Green, 082-123-4567
9. Please indicate number of each type available and/or employed:

eg. 1
  Artisans (Trade test certified)
10. Are all Vehicles/Drivers equipped with Radio Communication/Cell Phones?
 Radios      Cell Phones
11. Are any of the vehicles currently in use older than 5 years?
  Yes      No
12. Do all the above vehicles possess a full service history?
  Yes      No
13. Is your company BEE?
  Yes      No
14. Are you willing to invoice our corporate clients directly ?
(Payments are processed on a 30 day basis)
  Yes      No

15. Do you stock emergency materials?
  Yes      No
16. Do you make use of sub-contractors?
  Yes      No
Within a radius of 20 km  0-30 min      30-60 min   
 1-2 hrs    over 2 hrs   
17. Which areas (towns and suburbs) are you prepared to service?
(all applicants)

18. Please list any areas (such as townships) that you are
specifically NOT prepared to service:
(all applicants)

19. Rates:

(All rates to excl VAT) Normal
Pub Hol
1. Call-out (to include first hour’s labour)
2. Distance incl. in call-out fee
3. Rate per km thereafter
4. Labour rate per hour

20. Other relevant information you would like to add:

Company Name
Your Name
Position in Company
Business Phone
Business Fax
Cell Phone
Please enter this number in the box below
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