REGISTRATION FORM
Web Directories
Email: [email protected]
Office: +27 (0) 12 403 0120 / Fax: 086 759 2532
PO Box 11976, Queenswood, Pretoria, 0121
Website: www.panelbeatersdirectory.co.za
BASIC INFORMATION:
Country:
Province:
City:
Suburb:
Title (Business Name)
URL (Website Adress)
Street Adress:
Postal Adress:
Code:
BEE Rating:
CSI Rating
Business Telephone:
Business Fax:
Business Afterhours:
Business email:
Any Other Information:
Page 1/7
CONTACT PERSONS FOR PUBLICATION:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
PERSON RESPONSIBLE FOR FINANCE & ADMINISTRATION:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
Page 2/7
INSURANCE APPROVALS
AA Insurance Services
One Insurance
Absa
Orico
ABSA Direct
Outsurance
AIG
Pending
Alexander Forbes
Pinnafrica
Aon
PSG Insurance
Auto and General
Quicksure
Bidvest Insurance
Regent
BoE
Renasa
Botswana Insurance
SA Underwriters
Brolink
Santam
Budget Insurance
Sasria
Centriq
Smart Insurance
CIB Insurance
Stanbic
Compass
Telesure
CTU
Unitrans
Dial Direct
Unity
Direct Axis
Virgin
Discovery Insure
Virseker
Etana
XL Insurance Co
First for Women
Zurich
FNB Insurance
FSP
Glenrand MIB
Guard Risk
Hollard
IEMAS Financial Services
Indwe Risk Services
Innovation Group
Integrisure
Iwyze (Old Mutual)
King Price Insurance
Landmark
Lion of Africa
Lloyds
MARSH Insurance
Mi Way
Mmela
Momentum
MUA
Mutual and Federal
Natsure
Nedcor
N-National Assurance
Oakhurst
Page 3/7
OEM / FACTORY APPROVALS
Abarth
Isuzu
Alfa Romeo
Jaguar
Aston Martin
Jeep
Audi
Kia
Audi Aliminium
Lamborghini
BMW
Land Rover
BMW Dealership Approval
Lexus
Cadillac
Mahindra
Chana
Mazda
Cherry
Mercedes
Chevrolet
MG Rover
Chrysler
Mini
Citroen
Mitsubishi
CMC
Nissan
Daewoo
Opel
Daihatsu
Peugeot
Dodge
Porsche
FAW
Proton
Ferrari
Range Rover
Fiat
Renault
Ford
Rolls Royce
Foton
SAAB
Fuso
Ssang Yong
Geely
Subaru
GM South Africa
Suzuki
GWM
Tata
Honda
Toyota
Hummer
Volkswagen
Hyundai
Volvo
Infiniti
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COMMERCIAL APPROVALS
SPECIAL SERVICES
BELL
All Vehicles Outside Factory Warranty
CAT
Auto Electrical
DAF
Commercial Vehicles
ERF
Courtesy Car
Foden
Dent and Scratch Repair
Freightliner
Digital Assessments
Fuso
Factory Approvals Pending
International Trucks
Hail Damage
Isuzu Trucks
Major Structural Repair
Iveco
Marine Repair
Komatsu
Mechanical Work
MAN
Microdot ID Technology
Mercedes Truck and Bus
Motorcycle Repair
Nissan UD Trucks
Non Structural Repair
Peterbilt
Paint Protection
Renault Trucks
Paintless Dent Repair
Scania Trucks
Rim Repair
Tata Trucks and Bus
Rust Repair
Toyota Hino
Smash an Grab
Volvo Trucks
Spray Painting
Hyundai Commercial
Towing Service
Isuzu Trucks
Truck Towing
Renault Trucks
Upholstery
VW Commercial
Vehicle Tracking
SPECIAL SERVICES
SPECIAL SERVICES
AA Approved
AA
Auto Electrical
CRA
Avis
KZNTA
Bidvest
MIBCO
C Track
RFA
Equestria
RMI
Eskom
SAARSA
Europcar
SAMBRA
Ford East Cliff
SATRA
Hermanus Ford
STI
Hermanus Toyota
UTASA
Human Auto Ford
Hyundai Bellville
Hyundai Hermanus
Imperial GM
Inspecta Car Life Style Centre
Jaguar Centurion
McCarthy Menlyn
Nissan Hermanus
SA Taxi
Transnet
Volkswagen Hermanus
Wesbank
Page 5/7
•SMASH-PRO (Pty) Ltd t/a WEB DIRECTORIES • Regno: 2013/005016/07 • VAT No: 4200267682
• PO BOX 11976, Queenswood, 0121 • +27 (0)12 403 0120 or +27 (0) 713371635
Revised:14 April 2015
CLIENT NUMBER: (Office Admin)
BUSINESS NAME:
We welcome you as a valued client on the Web Directories!
We are ready to ensure that your business benefit continuously from increased customer service delivery and the leverage
power of the WEB to direct new customers to your doorstep - unlocking business opportunities for your business!
To enable us to deliver accurate and swift service , we ask that you please help us to conclude this easy registration
process – it is also required by SA Bank rules


Check on-line @
the applicable URL provided below that your application data was captured correctly
Sign this mandate and mail or fax a copy to:
o
o
E-mail: [email protected]
Fax: 086 759 2532
AGREEMENT
Implementation of this agreement is subject to client’s approval of the Information to be inserted and hosted on the applicable business
page in the Agreed Directory /s. The client accepts full responsibility for information displayed, specifically relating to Industry Contracts
& Endorsements.

WEB DIRECTORIES AGREES TO:
o
Host and promote the client’s information on the web based database/s in the standard format as displayed on the chosen
Directory – please indicate with mark in the applicable tick box/es:
(A) PANELBEATERS DIRECTORY - http://www.panelbeatersdirectory.co.za
(B) TOWING DIRECTORY - http://www.towingdirectory.co.za
(C) BROKER DIRECTORY - http://www.brokerdirectory.co.za
(D) AUTO REPAIR DIRECTORY - http://www.autorepairdirectory.co.za
o
Initialize & update such information from time to time, as & when requested to do so
THE CLIENT AGREES TO:
o
o
Supply accurate information in the format requested & continuously check the info displayed on the relevant page/s to be
correct – specifically regarding contractual agreements and endorsements
Payment of the agreed service fee in advance. Amount/s as indicated below (All amounts indicated is VAT Excluded)
Monthly Debit order
or EFT:
(A)
Annual cash
collection or EFT:
(A)
+(B)
+(C)
+(D)
=TOTAL
+(B)
+(C)
+(D)
=TOTAL
Once of Design & Programming Fee of R 200 per Business Page. Number
=
TOTAL FIRST MONTH D/O:
OR TOTAL ANNUAL DUE :
+ VAT
=
+ VAT
=
x R200 =TOTAL
MONTHLY THEREAFTER:
(VAT Incl.)
Page 6/7
o


If payment for services is to be done via EFT it should be made to the following company bank account
Smashpro FNB Pinnacle Branch Code: 250016 Account No: 62393019396 Reference: Client number.
Proof of Payment: to [email protected] Banking details also available on Invoice documentation
RENEWAL & CANCELLATION:
o
Monthly agreements - automatic renewed monthly, on a continuous basis. Cancellation with one(1) calendar month’s written
notice
o
Annual agreements – deemed to automatically renew annually on anniversary date, unless a cancellation notice is received
with one (1) calendar month’s written notice.
o
Change in membership fees (if any) communicated to the client’s nominated e-mail address:

Month-to-month agreements: one (1) calendar month

Annual contracts : one (1) calendar month before annual renewal date
BANK DEBIT ORDER INSTRUCTION
NAME (Business Name - Debtor) :
ADDRESS:
CONTACT PERSON:
CONTACT PERSON – E-MAIL:
DEBIT AMOUNT
(in advanced – Excluding VAT)
ONCE OFF DESIGN & PROGRAM FEE
( payable with first debit / EFT, Annual fee)
MONTHLY* / ANNUALY:
COMMENCEMENT DATE:
ACCOUNT TYPE:
BANK:
BRANCH CODE:
BANK ACCOUNT NAME:
ACCOUNT NO:
VAT NO:
This signed Authority and Mandate refers to our agreement as dated as on signature hereof. I / We hereby authorise you to issue and deliver payment
instructions to the bank for collection against my / our abovementioned account at my / our above mentioned bank (or any other bank or branch to which
I / We may transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our obligations as agreed to in this
document and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice
in writing of no less than 20 ordinary working days, and delivered to your address indicated above. The individual payment instructions so authorised to
be issued must be issued and delivered as follows

Monthly; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may
not be more or less that the obligation due; In the event that the payment day falls on a Saturday, Sunday or recognized South African public
holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account
to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in
my account;

Annually; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may
not be more or less than the obligation due;

I / We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks
and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must
be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to
this form before the issuing of any payment instruction. I / We shall not be entitled to any refund of amounts which you have withdrawn while this
authority was in force, if such amounts were legally owing to you.

MANDATE: I / We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned bank as if the instructions
had been issued by me/us personally.

CANCELLATION: I / We agree that although this Authority and Mandate may be cancelled by me / we, such cancellation will not cancel the
Agreement. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were
legally owing to you.

ASSIGNMENT: I / We acknowledge that this Authority and Mandate has been ceded to Netcash (Pty) Ltd as per your agreement with Netcash
(Pty) Ltd, but in the absence of such assignment of the Agreement, this Authority and Mandate will be null and void.
FOR BUSINESS – Duly authorised
Signed at __________________________ on the ______day of ___________________________ 20____
_____________________
____________________
NAME
&
SIGNATURE
____________________
WITNESS
Page 7/7