Name of Applicant / Company

Postal Address

Pysical Address

Postal Code

Website

Company VAT Number

Category
DiamondPlatinumSilver

Industry
OE motor manufacturers and component suppliersOther exporters except perishablesService providers (Agents, banks, forwarders, etc)Government entities interested in exportsMedia (Magazines, newspapers, websites, etc)Agricultural and agri-processingIndividual (Honorary, co-opted, committee members)Other Exporter Club contacts (Johannesburg, Cape Town)Forwarding and logisticsBankingInterest in exportingDirect exporterIndirect exporterService provider

Value of exports
Greater than R100mBetween R100m and R25mLess than R25m

Export Destination 1

Export Destination 2

Export Destination 3

Export Destination 4

Export Destination 5

Export Destination 6

Export Destination 7

Export Destination 8

Company representatives to be included on the database

Full Name (Representative 1)

Designation

Email Address

Cell Number

Phone Number

Full Name (Representative 2)

Designation

Email Address

Cell Number

Phone Number

Full Name (Representative 3)

Designation

Email Address

Cell Number

Phone Number

Full Name (Representative 4)

Designation

Email Address

Cell Number

Phone Number

Full Name (Representative 5)

Designation

Email Address

Cell Number

Phone Number

Declaration

I / We hereby apply for Exporters Eastern Cape membership and confirm remittance to the Club’s bank account with Standard Bank of SA Ltd, Port Elizabeth branch 050017, Account number 080196144.

I / We agree that upon becoming a member of Exporters Eastern Cape, I / We shall be bound by the provisions of its constitution. (Copy available on our website)

Full Name

Designation

Date