Welcome to Bosch extra - South Africa

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Retailer Participation Form

Customer Detail

Name :*
Surname :*
Registered Company Name:*
Company Registration Number:*
Trade Name:*
Physical Address :*
Post Code :*
Postal Address :*
Post Code :*

Contact Details

Telephone :*
Cellphone :*
Email :*

Sourcing Details

Currently buying from:

Wholesaler 1:*
Wholesaler 2:*
Wholesaler 3:*

Preferred Wholesaler:

Name :*
Branch :*
Telephone :*
Contact Person :*
I declare that I am the named business owner.
I have read and agree to the terms and conditions contained in Bosch eXtra brochure.
Welcome to Bosch extra, Please remember to quote your registration ID whenever you purchase select Bosch products from your Wholesaler.

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