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Please rush me my new business now!

I enclose my R190, which is full and final payment to register as an Agent for Reach Publishers.

Tel: 031-267-2049

Fax: 031-266-7167

RP4639

Name: ___________________________________________________

Address: _________________________________________________

_________________________________________________________

Postal Code: ______________________

Telephone Home: __________________________________________

Telephone Work: ___________________________________________

1. Enclose your cheque / postal order / cash for R190 with this form and post it to:

Reach Publishers, P.O. Box 1384, Wandsbeck, 3631.

2. Or for faster service, deposit the money into our account and fax the deposit slip together with this completed form to us at Fax: 031-266-7167

Bank: Standard Bank, Westville Branch, Branch Code: 045426

Account Name: Reach Publishers, Account Number: 053075994

3. We also accept major credit cards

Visa / Mastercard - (Circle One)

Expiry Date: (mm/yyyy): ______________________

Credit card number: _________________________________

Last three digits on rear of credit card: ____________

Your Signature: ___________________________

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