Company Name *Trading Name *Physical Address 1 *Physical Address 2 *Suburb *City *State *Select Country *Please select an option-AfghanistanAlgeriaAngolaBahrainBangladeshBotswanaBurkina FasoBurundiCameroonCentral African RepublicChadCote d’IvoireDjiboutiDR CongoEgyptEquatorial GuineaEthiopiaGabonGhanaGuineaIraqKenyaKuwaitLiberiaLibyaMadagascarMalawiMaliMauritaniaMoroccoMozambiqueNamibiaNigerNigeriaOmanPakistanQatarRepublic of the CongoRwandaSaudi ArabiaSenegalSierra LeoneSingaporeSouth AfricaSouth SudanSudanTanzaniaTogoTunisiaUgandaUnited Arab EmiratesZambiaZimbabwePostal Code *Website *Company Tel No. *Company Email *Business Type *Please select an option-DistributorGeneral DealerManufacturingMotor DealershipRetreaderSpares OutletTyre Outlet - PassengerTyre Outlet - Passenger & TruckTyre Outlet - TruckTyres, Brakes, Shocks, BalancingUsed Car DealerFranchise/AccreditationPayment Method *Please select an option-Cash PaymentLetter of CreditTelegraphic TransferCompany Reg No *Attach Company Registration Document *Choose FileNo file chosenDelete uploaded fileVAT/Sales Tax No. *Attach VAT/Sales Tax Registration Document *Choose FileNo file chosenDelete uploaded fileConsignee Name *Trading Name *Physical Address 1 *Physical Address 2 *Suburb *City *State *Select Country *Please select an option-AfghanistanAlgeriaAngolaBahrainBangladeshBotswanaBurkina FasoBurundiCameroonCentral African RepublicChadCote d’IvoireDjiboutiDR CongoEgyptEquatorial GuineaEthiopiaGabonGhanaGuineaIraqKenyaKuwaitLiberiaLibyaMadagascarMalawiMaliMauritaniaMoroccoMozambiqueNamibiaNigerNigeriaOmanPakistanQatarRepublic of the CongoRwandaSaudi ArabiaSenegalSierra LeoneSingaporeSouth AfricaSouth SudanSudanTanzaniaTogoTunisiaUgandaUnited Arab EmiratesZambiaZimbabwePostal Code *Website *Consignee Tel No. *Consignee Email *Primary Contact Details - Director/Owner 1First Name *Surname *ID No. *Attach Passport/ID Document *Choose FileNo file chosenDelete uploaded fileJob Title *Please select an optionOwnerDirectorTelephone (Area Code + Number) *Mobile *E-mail *Primary Contact Details - Director/Owner 2First NameSurnameID No.Attach Passport/ID DocumentChoose FileNo file chosenDelete uploaded fileJob TitleOwnerDirectorTelephone (Area Code + Number)MobileEmailTerms & Conditions *I agree with the Terms and Conditions (Supply Agreement available on request). Submit