Select type of product (Hold the ctrl key to select multiple items)? *
Please select one or more products from the list, note that some product selections will automatically default certain fields on the application form.
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Type of Product required.
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Will Afrox be installing any equipment on your site? *
Please indicate if you require AFROX to install any equipment on your site in order to support the product you are looking for.
If you are not sure please consult with your closest branch or the call centre on 0860 02 02 02
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Select type of account? *
Please indicate if you are applying for credit or a cash account.
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Type of Account required.
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Select type of legal entity? *
Please select the appropriate legal entity that you are applying for.
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Select type of customer? *
Are you applying as an end user or as a reseller of the Afrox product?
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If Other: *
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I hereby consent for Afrox to use the information provided. All information provided is given to the service provider is done so in agreement with our terms and conditions *
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I hereby give consent to Afrox, to conduct a credit check on our entity or in our personal capacity? *
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