Dealer Registration

*Registered Company/Business Name

Company/Business Registration Number

*Trading name of business

*VAT number or not VAT registered

*Physical business address (delivery purposes)

Contact Person Name and Surname

Contact Person Tel

*Contact Person Cell

*Contact Person Email 1

Contact Person Email 2

Description of business activities Description of business activities Dealer in firearms Outdoor equipment Ammunition Reloading equipment Firearm accessories Gunsmithing Other

Please specify other

Estimated annual turnover in firearm cleaning accessories?

Preferred communication language Preferred communication language English Afrikaans

Do you want to receive marketing related material, updated price lists and information on new products released by Omchem? Do you want to receive marketing related material, updated price lists and information on new products released by Omchem? Yes No

Terms and conditions: All information sent by us to you, is solely for the use of yourself and your business and shall not be released or shared to third parties. Pricing on products are confidential and shall not be disclosed to any other person. Do you agree to the terms and conditions? Terms and conditions: All information sent by us to you, is solely for the use of yourself and your business and shall not be released or shared to third parties. Pricing on products are confidential and shall not be disclosed to any other person. Do you agree to the terms and conditions? Yes No