Email address *
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User Type * – – – Select User Role – – –Individual CustomerB2B (requires approval)
Industry *
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Trading Name *
Registered Name *
Nemtek Account No.
Branch you usually buy from?
Company Reg No. *
Copy of registration document Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
Company VAT No. *
Copy of VAT certificate Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
First Name *
Last Name *
Phone Number *
Street Address *
Address Line 2
Country and State *
South Africa
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