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Netcare Supplier Application Form
 

Supplier Application

This is an application for registration on the Netcare supplier database of products and services
ALL SUPPLIERS INFORMATION WILL BE TREATED AS STRICTLY CONFIDENTIAL
Please complete your company details below, fields marked with a (*) are mandatory
 
* Please state type of commodity or service to be provided
* Please specify your industry sector
 
SECTION A - CONTACT DETAILS
Title
Surname
* "Trading As" Name of Business
* Registered Name of Business
Physical Address of Business
Code
Business Country
Postal Address of Business
Postal Address Code
Business Telephone Number
Sales person's email address
Accounts Clerk's email address
* Business email
 
SECTION B - COMMERCIAL EVALUATION
Business Registration Number     (if applicable)
VAT Registration Number     (if applicable)
* Tax Number of Business     (if applicable)
Type of Firm
Company Classification
Total number of years
the firm has been in business
Please indicate the geographical areas where your business is willing and capable of supplying Netcare
Previous name(s) of business    (if applicable)