Welcome to CMA Info! Please tell us a bit about yourself.

COMPANY DETAILS

First Name:

Address Line 1:

Surname:

Address Line 2:

ID / Passport Number:

Suburb:

Postal Code:

Registered Name:

Province:

For Companies a valid Agency FFC or a CIPC document is required. Agents signing up in their personal capacity - a valid FFC certificate is required.

Trading Name:

Email:

Website Address:

Telephone:

Mobile:

Sales Agent:

Subscription Commencement Date:

Unique Voucher Code:

BANKING DETAILS

Account Holder:

Billing Contact:

Account Number:

Billing Email:

Bank:

Billing Mobile:

Branch Code:

Debit Date:

I have read and agree to the Debit Order Payment Instruction

TERMS & CONDITIONS OF USE

I have read, understood and agree to the following:

	Price List
	Terms & Conditions
	Privacy Policy
	Appendix B Policy for Obtaining Consent from Customers
	Consent to process Personal Information
	We hereby confirm that our company does not collect, store, or maintain any payment profile information that may be subject to reporting to SACRRA or any registered Credit Bureau, in accordance with applicable data protection and credit information regulations

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