ORGANISATION IDENTIFICATION

Registered Name of the Organisation *

BILLING INFORMATION

Title, Name and surname *

E.g. Mr Nelson Mandela

Phone number *

Email *

Postal address *

Format: Building/Post box/street and number, Suburb/town/city, Postal/zip code, Province/state, Country For example: PO Box 1713, Randburg, 2125, Gauteng, South Africa

Delivery address *

Format: Building/floor/office number, Street and number, Suburb, Town/city, Area/postal/zip code, Province/state, Country For example: Office G17, The Workspace, 1 Maxwell Drive, Sunninghill, Sandton, 2191, Gauteng, South Africa

VAT number (if applicable)

SAMRA annual fees should be billed in: *

Are you required to supply SAMRA with an order number for billing purposes? *

If you select yes, SAMRA will not issue a tax invoice to the organisation but instead a quote (proforma invoice), until an order number has been supplied to SAMRA by the organisation.

Who should be billed for the annual fees for the organisation's Associate members' professional recognition, if applicable? *

i.e. for SAMRA Accredited Marketing Researchers and SAMRA Partners

TERMS AND CONDITIONS

I, the authorised representative for the above organisation, hereby certify that: *

Select Yes to indicate agreement

	Yes
The information set out in this submission is true and correct to the best of my knowledge.
I undertake, on behalf of the above organisation, to ensure payment of any fees due to SAMRA.

Organisation Billing Details

ORGANISATION IDENTIFICATION

BILLING INFORMATION

TERMS AND CONDITIONS

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