Diesel Distribution Application Form To Become A Regional Distributor Invites Distributors For To The Bulk Distribution of Diesel Products, Heavy Oil & Carbon Black In The Region and Province They Are Located Within a 100Km Radius. The Company Also Invites Distributors To Establish Distribution Centres (Warehouses) For The Purpose Of Distributing Diesel & Carbon Black. E-102 Application Form Important Notice 1. Applications Are Treated On A First-Come, First-Serve Basis 2. Applications With Missing Documents Will Not Be Processed 3. Registration Process Will Be Within 7 Days From Date Of Submission As We Are Finalise Each Application Within 7Days. 4. Any Outstanding Documentation Not Submitted Within 7 Days From Date Of Submission Of This Application Will Render Application To Be Terminated. Please Ensure All Documentation Required Is Submitted To Avoid Termination. 5. All Applications Must Be Submitted At Our Office Or Emailed To admin@dieselsouthafrica.com whichever is convenient is to you acceptable with us as long as it is submitted in either of these two ways herein point 5 of this notice. 6. Each page of this application must be initialled and submitted. 7. This application will take 7 business days to process due the high volume of applications. We plead in advance with all applicants to be patient. Page 1 of 5
Title: First Name: Surname: ID/Passport No: Company Name (Optional) Company Reg (Optional) Age: Sex: Email: Tel (H): Tel (W): Cell: Street Address: Suburb: City: Province: Area Securing: Please put the Area you would like to operate the town or city and the state the province. We will check on which we can still appoint you in on availability from your below preferences. Kindly put 1 to 3 preferences. Area Securing: 1 st preference 2 nd preference 3 rd preference 4 th preference 5 th preference 6 th preference Please put them in this format: Area (Town or City) and Province) Page 2 of 5
Applicant Acknowledgements 1. The applicant acknowledges that they have to be over the legal age of 18 years to initial or sign this application form. 2. The applicant acknowledges that they must submit a ID Copy or Passport or Permit to be in the Republic of South Africa to enter into an agreement with our company and to apply with our company. 3. The applicant acknowledges that the distribution application fee is R2,500 and that after appointment has be done, they will pay a registration fee of R15,000 within 30 days of issue of the appointment letter in the region and area they have reserved and been appointed in. 4. The applicant acknowledges that to cancel this application they would need to send a 10 days written cancellation notice and 60 days written notice if they are cancelling the entire registration fee once registered. 5. The applicant acknowledges that the company reserves the right to cancel this application at any stage of which the distributor would be entitled to the full refund of whatever monies already paid. 6. The applicant will follow all procedures and processes regarding the distribution opportunity and guidelines. 7. The applicant acknowledges that he will get a R2.50 profit share. That we promise our clients a 30% cheaper rate from normal diesel at all times even if we would increase our price with accordance to normal diesel increases it will however always be at more than 30% cheaper than normal diesel and that our customers will always be serviced to the distributors best capable ability Page 3 of 5
Our Company Banking Details: Please email this Signed Application, Proof of Application Fee Payment, and Copy of ID to admin@dieselsouthafrica.com, banking details for application fee payment are below. You can pay in either of our business account below: Our Business Account: Bank: Nedbank Account Holder: BTN FUEL GROUP Account Number: 117 221 6517 Branch Code: 198 765 Reference: Use Your ID or Passport Number, Please submit the following 3 Documents for your application to be processed: 1. This E-102 Form initialled on each page and signed 2. Proof of payment of the R2,500 application fee 3. Copy of your ID or Passport Page 4 of 5
I the below applicant confirm that I have read all the terms and pages of this application form and have gone through the company s business model with full understanding and will adhere to all processes and procedures of the company and project at all times. I fully understand the business and distribution business model and I am applying to become a Regional Distributor with the company in my region indicated on page 2 of this form. I have paid the reservation deposit into the above company account and have submitted all required documents with this application for processing. Applicant Signature : Applicant Name & Surname: Applicant ID Number or Passport No: Application Date: Page 5 of 5
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