EMIA CUSTOMER PROFILE FORM

Would you be interested in attending a workshop in your province: Yes No

COMPANY INFORMATION

Company Name:
Company Reg. no / Sole Propriator ID no: Entity Type: Province where based:
BEE Status: Company turn over (Rands)-previous financial year:
Industry Sector: Manufacturing Sector Service Sector Sector Breakdown:
Products manufactured / Services rendered:
Are you currently exporting: Yes No

MD/CEO/OWNER'S INFORMATION

Name and Surname: Telephone Number: (eg:012-1234567)
E-mail address: Mobile Number:
Fax Number: (eg:012-1234567)

EXPORT INFORMATION

For how long have you been exporting:
To which market(s) are you exporting: Americas East Asia West Asia Europe1 Europe2
East Africa & SADC West Africa & Middle East
Countries as per breakdown above:
Note: Please use CTRL key to select multiple countries
Other Countries Exported to:

PERSON RESPONSIBLE FOR EXPORTS IN YOUR COMPANY

Name and Surname: Designation:
Mobile Number: Telephone Number: (eg:012-1234567)
Fax Number: (eg:012-1234567) Email Address: