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Online Enquiry Form
Become a Distributor
Completing this online form only takes a few minutes. Enter the information below and then click the Apply button. Alternatively, you may
download the PDF form
.
Fields marked (*) are mandatory
.
Company Name
*
Date of Company Establishment
Owners Name
Company's Postal Address / Town
Company's Telephone / Fax No:
Company's Email Address
*
Facilities in Place for Distribution:
Shop
Warehouse
Other
If other, please describe
Products to be offered in these facilities
Note: Your Busines Registration Certificate and Actual Tax Clearance certificate should be faxed to us at+233 22 302184
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