Become a Dealer – Secure Side (Pty) Ltd

01

Business details

Type of business *

Registered name of business *

Trading name of business optional

Nature of business *

Company or NPO registration number / ID number *

Total turnover — last financial year *

02

Address

Billing address

Street address *

Suburb *

City / town *

Province *

Postal code *

Delivery address is the same as billing

Delivery address

Street address *

Suburb *

City / town *

Province *

Postal code *

03

Primary contact

Who should we get in touch with day-to-day?

Contact name *

Cell number *

Confirm cell number *

Email address *

Confirm email address *

Add a secondary contact (optional)

04

Authorised representative

The person completing this application on behalf of the business.

Full name *

ID number *

Position *

Date

I acknowledge and agree to Secure Side's Privacy Policy. I agree to check the Privacy Policy periodically for changes that may have taken effect since the date of posting. I acknowledge and agree to Secure Side's Terms and Conditions. I agree to check the Terms and Conditions periodically for changes that may have taken effect since the date of posting. I, the undersigned, certify that I am duly authorised to sign this form on behalf of the business, and that the information contained in this application is true and correct.

05

Documents

PDF, JPG or PNG. Max 5MB per file.

ID copy (of the authorised representative) *

CIPC registration document not required for sole proprietors

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Apply for a trade account

Business details

Address

Primary contact

Authorised representative

Documents

Contact info

Account

Infomation

Payment methods