mail testing

Mail sending Test (to Lee’s Gmail account :
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BP Form Test :

Registered Name Of Business: *
Trade Name of Business (if different): *
Office Tel. Number (or cellular): *
Physical Address: *
Company Website URL: *
Type of Business: (Form of incorporation): *
Company Registration Number: *
VAT Registration Number: *
Nature of Business: *
Short Description of Business: *
Sales Person Spoken To:

Email address for Quotes & Invoices: *
Cell number for SMS payment confirmations:

Primary contact person name:
Primary Mobile Number:
Primary Email Address:
Accounts Name:
Accounts Tel:
Accounts Email:
Buyer Name:
Buyer Tel:
Buyer Email:
Additional Contacts to receive Product & Marketing Information: Name and email






Which other trade suppliers are you registered with?

Where did you hear about us? *
Referral Company: *


I , ID Number in my capacity as of hereby confirm that:


1. I am duly authorised to enter into agreements for/on behalf of the applicant,
2. I have read and understood the Miro distribution terms and conditions and accept them as binding upon the applicant,
3. I understand that this is a business partner application only and not a credit application.

I have read and accept the terms and conditions  terms

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