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CUSTOMER DETAILS FORM: C.O.D.

Name of Colombo Representative: _______________________________________________ Date: __________________________________


Customer Details:
Full Business Name:
Postal Address:
Delivery Address:

Telephone Number:
Email Address:
Web URL:
Vat Number:
Billing Information:
Contact Person:
Billing Address:

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________________________________________ Fax Number: _______________________________________
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Telephone Number:
Cell phone Number:
Email Address:

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Banking Details:
Name of Account:
Bank Name:
Branch Code:
Bank Account Number:
Account Type:

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Trade References: (if requested by sales representative)


1. Full Name:
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Address:
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Telephone Number:
________________________________________ Contact Person: _____________________________________
2.

Full Name:
Address:
Telephone Number:

3.

Full Name:
Address:
Telephone Number:

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________________________________________ Contact Person: _____________________________________

369 GALE STREET // DURBAN // KWAZULU-NATAL // SOUTH AFRICA // TEL: +27 31 205 3283 // FAX: 0865 915 539
COLOMBO TEA AND COFFEE COMPANY (PTY) LTD, REG NO 1917/003107/08
DIRECTORS: V RICHARDSON // E RICHARDSON // K FRASER

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