Apply for Lay-by

• • Personal Details
  • Residential Address Details
  • Contact Details
  • Delivery and EGT
  • Marketing Questions
  • Terms & Conditions

• Title *
  Ms Mr Dr Miss Mrs Prof Rev Adv Honorable

• Surname *

• Name *

• Initials *

• Citizenship *

• Identification type *
  Passport Number SA ID Number

• Identification *
  Type in based on chosen identification type

• Temporary Resident Permit No.
  Only necessary if passport number is used

• Temporary Resident Permit Expiry Date

• Proof of ID

• Date of Birth *

• Gender *
  Male Female

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• Building / Complex

• Type of Dwelling *
  Flat House Hostel Informal Room Town house / Cluster Other

• Home Ownership *
  Boarder Owned Living with Parents Rented

• Street & No *

• Suburb *

• City *

• Province *
  Eastern Cape Freestate Gauteng KwaZulu - Natal Limpopo Mpumalanga Northern Cape North West Province Western Cape

• Country *
  South Africa

• Postal Code *

• Preferred Store *

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• Cell Number *

• Email Address *

• Home Phone Number

• Employer Telephone Number *

• Home Language *
  English Afrikaans Swazi Tsonga Tswana Zulu North Sotho South Sotho Xhosa Venda Ndebele Other

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• May we deliver the products to your home? *
  • Yes
  • No

• Building/Complex

• Type of Dwelling
  Flat House Hostel Informal Room Town House/Cluster Other

• Home Ownership
  Boarder Owned Living with Parents Rented

• Street & No

• Suburb

• City

• Province
  Eastern Cape Freestate Gauteng KwaZulu - Natal Limpopo Mpumalanga Northern Cape North West Province Western Cape

• Country
  South Africa

• Postal Code

• May we offer you Extended Guarantee on your product? *
  • Yes
  • No

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• May we and our associated companies market to you? *
  • Yes
  • No

• Marketing Language
  English Afrikaans Zulu Xhosa Sesotho

• Marketing Correspondence Method
  Email Post SMS Telephone

• Statement Correspondence Method (Post or Email)
  Email Post

• For future marketing may we do a credit bureau check on you? *
  Yes No

• How much deposit do you wish to pay? (We require a minimum of R100) *
  R100 R200 R300 or more

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• I accept the T's & C's *
  • Yes

  CLICK HERE TO READ TERMS AND CONDITIONS

• Subscribe to newsletter
  • Yes

• reCaptcha *

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