To register, kindly fill the application form below.
Please ensure that you can provide a soft copy of the following documents after we contact you:
For more information, please call the Sales Representative at 07035255888. Completed forms/applications can also be sent by email to firstname.lastname@example.org
Name of Registered Business
Name of Director/Promoter
Certificate of Incorporation Number
Date of Incorporation
Attach a copy of your Certificate of Incorporation (.pdf, .jpg, .png files allowed. File must not exceed 5MB)
What is your business type? (Please select all that apply)
Retail StoreDealerWholesale DistributorOther (please specify below)
Do you currently sell sanitizers?
Proposed area of coverage
Proposed amount of investment
Storage facility size (in square meters)
Additional Information (if any)