|
Company name:
__________________________________________________________ |
|
Contact person:
__________________________________________________________ |
|
Physical Address:
__________________________________________________________ |
| P.O.Box:
__________________________________________________________ |
|
Tel:____________________________
|
Fax: _____________________________________ |
|
eMail: __________________________
|
VAT No:
__________________________
|
Please tick the length you wish to purchase
|
 |
Length |
Price |
Vat |
Total |
| |
100m |
4 650.00 |
651.00 |
5 301.00 |
| |
200m |
7 440.00 |
1 041.60 |
8 481.60 |
| |
300m |
10 050.00 |
1 407.00 |
11 457.00 |
| |
400m |
11 960.00 |
1 674.40 |
13 634.40 |
| |
500m |
14 380.00 |
2 013.20 |
16 393.20 |
| |
1000m |
22 425.00 |
3 139.50 |
25 564.50 |
| |
2000m |
43 820.00 |
6 134.80 |
49 954.80 |
| |
5000m |
105 250.00 |
14 735.00 |
119 985.00 |
|
Payment Options
Enclosed please find my cheque for R
...................................................made out to Aids Week
Business Bannerthon
OR |
Enclosed
please find confirmation of direct deposit into account:
Aids Week Business
Bannerthon
Bank: Nedbank
Branch: Northrand Branch code: 146905
Acc.
No. 1469061635 |
|
Signature ........................................
Date .................................
|
I
also request that the Bannerthon organisers challenge the following
companies on my behalf:
|
Company Name: |
________________________ |
________________________ |
|
Contact Person: |
________________________ |
________________________ |
|
Tel No: |
________________________ |
________________________ |
|
Fax No: |
________________________ |
________________________ |
|
eMail: |
________________________ |
________________________ |
|
