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Customer Details Form

Company Name*

Client Full Name*

Landline Number

Company VAT No.

Client Email*

Mobile Number*

Delivery Address*

Postal Address*

Please indicate who should receive the Invoice(s) and Statement(s).

Full Name*

Optional Email 1

Accept Electronic Statements? *

Yes

Email*

Optional Email 2

I / We hereby certify that the herein contained information is true and correct in each and every aspect any may be relied upon, and undertake to notify Kaldera (Pty) Ltd in writing of any change in details shown above.
All invoices to be settled upon receipt thereof. Interest will be charged at the prevailing interest rate on any overdue accounts.
All goods remain vested in Kaldera (Pty) Ltd until paid for in full.
I am an authorised representative of the above mentioned company and agree to the terms above.

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