BUSINESS REGISISTRATION FORM

Registration Form

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Important notes:

Your profile on Assist247 acts as a mini website that helps to promote your brand and services, and you can also continually improve your profile by updating it and adding photos. Where you rank on the list of available providers in your area is determined purely by your monthly budget and how many visits you have received. Service Providers with higher budgets can therefore expect to spend more time at the top of the list, even though those with lower budgets will also get an opportunity. Simply choose your budget between R150 and R2000 per month for individual business listings (contact us if you have more than one branch) and enter the amount below.
Please enter your business details exactly as you want them to show on the website.
Confidential information like your bank details will not be displayed on the site.
Debit orders are only processed once a month, and ALWAYS on the 7th - we would really appreciate it if you could please ensure you have the necessary funds available on that date.

Membership Information

Total Monthly Budget
in multiples of R50, excl VAT:
(R150 Minimum listing fee)

Payment Method (please select)

Monthly Debit Order

Monthly EFT (on invoice)

6 Monthly EFT (pay only for 5 months, on invoice)

12 Monthly EFT (pay only for 10 months, on invoice)

Amount Including VAT

Please enter your details:

Company Name

VAT Registration Number (if exists)

Contact Name

Position in Company

E-mail Address

Street Address

Suburb

City/Town

Postal Code

Business Phone(s)

Cell Phone(s)

Normal Business Hours / 24Hrs?

Normal Business Hours

24Hrs

Website Address

(If you have a website, enter in the website address)

Main Service you provide

If the service is not listed above please indicate here:

Additional Services you provide

Main Area where you would you like your business to registered:

(This would be the area where your business is situated, and would be a town like Benoni or City Area like Pretoria East, not a suburb)

If the area is not listed above please indicate area here:

Additional Areas

(Nearby towns or cities that you are prepared to service)

Is your business BEE Registered?

If yes, please tick the box and after completing this form, fax a copy of your BEE certificate to 086 537 6238 or email it to

BEE Registered

Person Authorising this application
(Name and Surname)

Registration Number of business
(where available)

Additional Notes
(Please include anything special about your business that will be displayed right below your business name on your listing page, as well as on the 'Available Providers in an Area' list)