Business Registration Form

Signup / Subscription Form or Once-off

Please provide all required details to apply for Pro Germ Control signup subscriptions. Subscription fees apply R350. Discount of 15% to all subscriptions. To all clients please mail and specify size / sqm / height / length of building. Please fill out your details in the form below in order to receive a speedy quote.
Business Owner / Contact Person*

First NameLast Name
Business Name*
Contact Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Type of Business*
Specify Business if not listed above.
Subscription*

Once - Off1 Year
Swabs*

NoYes
Please specify the following for quote: Length / Width / Height or Square meterage.
Specify L / W / H or Square meterage.*
Should be Empty:

Signup / Subscription Form or Once-off