PCO Cash Customer Registration

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Are you a registered PCO or reseller of PCO/Hygiene products? Then complete this form to take advantage of our PCO pricing.

Your details are safe with us as we will only use them for internal use.

If you have any questions, please email info@pesafrica.net.

Your Details

Trading Name (this is the company name for the Tax Invoice) *

Full Names of Applicant (your name, please) *

Company Registration Number *

VAT Registration Number *

P-Number from Dept of Agriculture *

P-Number Expiry Date *

YYYY

Delivery Address *

Mobile Number *

Email Address *

Which region do you operate in? *

Central and Southern Gauteng (Joburg)

Northern Gauteng & Pretoria

Western Cape

Eastern Cape

Kwa-Zulu Natal

Free State

Northern Cape Province

Mpumalanga

North West Province

Limpopo

Other:

Required

Keep us updated with your latest specials and promotions. *

YES PLEASE!

Not right now, thanks!

Thank you!

We'll send you a Customer Number once you've been added to our system. Please remember to use this for your next order.

T&C's

This is not a credit application, so payment before collection or delivery of your order will still be required.

Submitting this form authorises Pathogen & Environmental Solutions (Pty) Ltd to add you to their customer database.

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