Complete your Agency Application Online

Agency Info - Step 1 of 3

Business Full Name *

Owners Name *

Owner Contact Number *

Email *

Partners involved in the decision making process *

Business Address *

Business Telephone Number *

Company VAT Number *

Company Registration Number *

Company WCA Number *

Website *

BEE Level *

Describe which industry/'s you are currently servicing *

List the type of repairs / supplies you currently provide to your customers *

How long have you been in business? *

How many people do you have on your team and list the various functions they perform (ie. internal sales, bookkeeper ect) *

What type of marketing are you currently doing for your own business and explain the effectiveness of each strategy *

How do you think will a relationship with Exclusive Hydraulics & Engineering help your business? *

Please expand on the assistance you will need from Exclusive Hydraulics & Engineering to ensure that you grow your business when entering into an agency agreement *

What type and how many vehicles do you have that cn be used for collections/deliveries and off-loading of goods/items for repair *

To safegaurd your business and prevent us from inadvertently contact or market to your customers in your territory, are you prepared to divuldge your customer list to us after the signing of the agency agreemen, and continue to do so on a monthly basis? *

Please note: Terms & conditions will be detailed at length in the Agent agency agreement to protect both parties.

Describe the area you would like your Agency to operate in (towns/suburbs) *

I agree that a basic audit of our facilities and procedures may be performed at a time suitable to us, by a representative from Exclusive Hydraulics & Engineering (Pty) Ltd. *

I understand that this is not an agreement to act on behalf of Exclusive Hydraulics & Engineering (Pty) Ltd, but that there will be further discussions upon approval of my application, followed by the signing of a non-disclosure agreement by both parties as well as the negotiated agreed terms and conditions. *

Full Name & Surname *

Date / Time *

Signature