Resellers Registration Form

Thank you for taking the time to register your company as a reseller with us.

We are looking forward to being your purified water supplier of choice.

Registered Company Name, Or trading As Name *

Name you are going to be using to promote your water

Type Of Business

Main Focus Of The Company (Ex, Branding)

Registration Number

VAT Number (if applicable)

Email

Contact Number *

Please provide the number that is linked to your whatsapp

Name of Contact Person For Company *

First

Last

Registered Company Address *

(Physical Address)

Company Postal Address

If Not The Same As Physical Address

Submit