Client Contact Form

Trading Name *

VAT Number *

Company Reg. Number *

Contact Name & Surname *

First

Last

Email *

Tel Number *

Mobile Number

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Postal Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

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Director 1 Details

Director 1 Name & Surname *

First

Last

Director 1 Email *

Director 1 Contact Number *

Director 1 ID Number *

Director 2 Details

Director 2 Name & Surname

First

Last

Director 2 Email

Director 2 Contact Number

Director 2 ID Number

Accounts Department

Accounts Contact Name & Surname *

First

Last

Accounts Email *

Accounts Contact Number *

Please send following supporting documents with filled in client contact sheet

POPIA Compliance Document *

I have read and accepted Teclogix POPIA compliance

Read our Website Privacy Terms & POPI Conditions

Copy of Company Registration & VAT Number or ID Number.

Click or drag files to this area to upload. You can upload up to 3 files.

Director 1 Details

Director 2 Details

Accounts Department

Please send following supporting documents with filled in client contact sheet

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