REGISTRATION FORM Web Directories Email: info@smashpro.co.za Office: +27 (0) 12 403 0120 / Fax: 086 759 2532 PO Box 11976, Queenswood, Pretoria, 0121 Website: www.panelbeatersdirectory.co.za BASIC INFORMATION: Country: Province: City: Suburb: Title (Business Name) URL (Website Adress) Street Adress: Postal Adress: Code: BEE Rating: CSI Rating Business Telephone: Business Fax: Business Afterhours: Business email: Any Other Information: Page 1/7 CONTACT PERSONS FOR PUBLICATION: INSERT CONTACT PERSON Contact Person: Designation: Phone: Email: INSERT CONTACT PERSON Contact Person: Designation: Phone: Email: INSERT CONTACT PERSON Contact Person: Designation: Phone: Email: INSERT CONTACT PERSON Contact Person: Designation: Phone: Email: INSERT CONTACT PERSON Contact Person: Designation: Phone: Email: PERSON RESPONSIBLE FOR FINANCE & ADMINISTRATION: INSERT CONTACT PERSON Contact Person: Designation: Phone: Email: Page 2/7 INSURANCE APPROVALS AA Insurance Services One Insurance Absa Orico ABSA Direct Outsurance AIG Pending Alexander Forbes Pinnafrica Aon PSG Insurance Auto and General Quicksure Bidvest Insurance Regent BoE Renasa Botswana Insurance SA Underwriters Brolink Santam Budget Insurance Sasria Centriq Smart Insurance CIB Insurance Stanbic Compass Telesure CTU Unitrans Dial Direct Unity Direct Axis Virgin Discovery Insure Virseker Etana XL Insurance Co First for Women Zurich FNB Insurance FSP Glenrand MIB Guard Risk Hollard IEMAS Financial Services Indwe Risk Services Innovation Group Integrisure Iwyze (Old Mutual) King Price Insurance Landmark Lion of Africa Lloyds MARSH Insurance Mi Way Mmela Momentum MUA Mutual and Federal Natsure Nedcor N-National Assurance Oakhurst Page 3/7 OEM / FACTORY APPROVALS Abarth Isuzu Alfa Romeo Jaguar Aston Martin Jeep Audi Kia Audi Aliminium Lamborghini BMW Land Rover BMW Dealership Approval Lexus Cadillac Mahindra Chana Mazda Cherry Mercedes Chevrolet MG Rover Chrysler Mini Citroen Mitsubishi CMC Nissan Daewoo Opel Daihatsu Peugeot Dodge Porsche FAW Proton Ferrari Range Rover Fiat Renault Ford Rolls Royce Foton SAAB Fuso Ssang Yong Geely Subaru GM South Africa Suzuki GWM Tata Honda Toyota Hummer Volkswagen Hyundai Volvo Infiniti Page 4/7 COMMERCIAL APPROVALS SPECIAL SERVICES BELL All Vehicles Outside Factory Warranty CAT Auto Electrical DAF Commercial Vehicles ERF Courtesy Car Foden Dent and Scratch Repair Freightliner Digital Assessments Fuso Factory Approvals Pending International Trucks Hail Damage Isuzu Trucks Major Structural Repair Iveco Marine Repair Komatsu Mechanical Work MAN Microdot ID Technology Mercedes Truck and Bus Motorcycle Repair Nissan UD Trucks Non Structural Repair Peterbilt Paint Protection Renault Trucks Paintless Dent Repair Scania Trucks Rim Repair Tata Trucks and Bus Rust Repair Toyota Hino Smash an Grab Volvo Trucks Spray Painting Hyundai Commercial Towing Service Isuzu Trucks Truck Towing Renault Trucks Upholstery VW Commercial Vehicle Tracking SPECIAL SERVICES SPECIAL SERVICES AA Approved AA Auto Electrical CRA Avis KZNTA Bidvest MIBCO C Track RFA Equestria RMI Eskom SAARSA Europcar SAMBRA Ford East Cliff SATRA Hermanus Ford STI Hermanus Toyota UTASA Human Auto Ford Hyundai Bellville Hyundai Hermanus Imperial GM Inspecta Car Life Style Centre Jaguar Centurion McCarthy Menlyn Nissan Hermanus SA Taxi Transnet Volkswagen Hermanus Wesbank Page 5/7 •SMASH-PRO (Pty) Ltd t/a WEB DIRECTORIES • Regno: 2013/005016/07 • VAT No: 4200267682 • PO BOX 11976, Queenswood, 0121 • +27 (0)12 403 0120 or +27 (0) 713371635 Revised:14 April 2015 CLIENT NUMBER: (Office Admin) BUSINESS NAME: We welcome you as a valued client on the Web Directories! We are ready to ensure that your business benefit continuously from increased customer service delivery and the leverage power of the WEB to direct new customers to your doorstep - unlocking business opportunities for your business! To enable us to deliver accurate and swift service , we ask that you please help us to conclude this easy registration process – it is also required by SA Bank rules Check on-line @ the applicable URL provided below that your application data was captured correctly Sign this mandate and mail or fax a copy to: o o E-mail: info@smashpro.co.za Fax: 086 759 2532 AGREEMENT Implementation of this agreement is subject to client’s approval of the Information to be inserted and hosted on the applicable business page in the Agreed Directory /s. The client accepts full responsibility for information displayed, specifically relating to Industry Contracts & Endorsements. WEB DIRECTORIES AGREES TO: o Host and promote the client’s information on the web based database/s in the standard format as displayed on the chosen Directory – please indicate with mark in the applicable tick box/es: (A) PANELBEATERS DIRECTORY - http://www.panelbeatersdirectory.co.za (B) TOWING DIRECTORY - http://www.towingdirectory.co.za (C) BROKER DIRECTORY - http://www.brokerdirectory.co.za (D) AUTO REPAIR DIRECTORY - http://www.autorepairdirectory.co.za o Initialize & update such information from time to time, as & when requested to do so THE CLIENT AGREES TO: o o Supply accurate information in the format requested & continuously check the info displayed on the relevant page/s to be correct – specifically regarding contractual agreements and endorsements Payment of the agreed service fee in advance. Amount/s as indicated below (All amounts indicated is VAT Excluded) Monthly Debit order or EFT: (A) Annual cash collection or EFT: (A) +(B) +(C) +(D) =TOTAL +(B) +(C) +(D) =TOTAL Once of Design & Programming Fee of R 200 per Business Page. Number = TOTAL FIRST MONTH D/O: OR TOTAL ANNUAL DUE : + VAT = + VAT = x R200 =TOTAL MONTHLY THEREAFTER: (VAT Incl.) Page 6/7 o If payment for services is to be done via EFT it should be made to the following company bank account Smashpro FNB Pinnacle Branch Code: 250016 Account No: 62393019396 Reference: Client number. Proof of Payment: to finance@smashpro.co.za Banking details also available on Invoice documentation RENEWAL & CANCELLATION: o Monthly agreements - automatic renewed monthly, on a continuous basis. Cancellation with one(1) calendar month’s written notice o Annual agreements – deemed to automatically renew annually on anniversary date, unless a cancellation notice is received with one (1) calendar month’s written notice. o Change in membership fees (if any) communicated to the client’s nominated e-mail address: Month-to-month agreements: one (1) calendar month Annual contracts : one (1) calendar month before annual renewal date BANK DEBIT ORDER INSTRUCTION NAME (Business Name - Debtor) : ADDRESS: CONTACT PERSON: CONTACT PERSON – E-MAIL: DEBIT AMOUNT (in advanced – Excluding VAT) ONCE OFF DESIGN & PROGRAM FEE ( payable with first debit / EFT, Annual fee) MONTHLY* / ANNUALY: COMMENCEMENT DATE: ACCOUNT TYPE: BANK: BRANCH CODE: BANK ACCOUNT NAME: ACCOUNT NO: VAT NO: This signed Authority and Mandate refers to our agreement as dated as on signature hereof. I / We hereby authorise you to issue and deliver payment instructions to the bank for collection against my / our abovementioned account at my / our above mentioned bank (or any other bank or branch to which I / We may transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our obligations as agreed to in this document and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 20 ordinary working days, and delivered to your address indicated above. The individual payment instructions so authorised to be issued must be issued and delivered as follows Monthly; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less that the obligation due; In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account; Annually; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less than the obligation due; I / We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you. MANDATE: I / We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned bank as if the instructions had been issued by me/us personally. CANCELLATION: I / We agree that although this Authority and Mandate may be cancelled by me / we, such cancellation will not cancel the Agreement. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you. ASSIGNMENT: I / We acknowledge that this Authority and Mandate has been ceded to Netcash (Pty) Ltd as per your agreement with Netcash (Pty) Ltd, but in the absence of such assignment of the Agreement, this Authority and Mandate will be null and void. FOR BUSINESS – Duly authorised Signed at __________________________ on the ______day of ___________________________ 20____ _____________________ ____________________ NAME & SIGNATURE ____________________ WITNESS Page 7/7
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