Distributor Details

If you would like to become a Telkom Mobile regional distributor, please complete the form below.

Personal Details

First Name *
Last Name *
Gender * Male Female
Id Number / Passport *
Email Address *
Contact Number 1 *
Contact Number 2
Province *
City *

Organization

What is your company's (SA) registration number? *
What is your company's VAT Number? *
Does your company have a current account at an S.A. bank?* Yes No
What is your company's website address?
What is your function in that company?*
How many employees are currently working for your company?*
What was the turnover (revenues) of your company in 2009?* R
What is your company's BBBEE rating?* Contributor

Presence

How much airtime is your company currently distributing/reselling per month?*
None R 1-10,000 R 10,001-100,000 R 100,001-1,000,000 More than R 1,000,000
How much mobile starter packs is your company currently distributing/reselling per month?*
None 1-10 11-100 101-1000 More than 1000
What (other) kind of business is your company mainly involved in (please provide examples)?*
Which regions of SA does your company operate in?*
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
In which of the below townships/suburbs is your company active?*
Eastern Cape
New Brighton/KwaZakhele
Zwelitsha
Mdantsane
Umtata
Free State
Kwa-mashu
Umlazi
Umbumbulu
Ndwendwe
Gauteng
Soweto
Orange Farm/Evaton/Sebokeng
Katlehong/Tokoza/Vosloorus/Spruitview
Tembisa
Soshanguve
Duduza/Tsakane
Daveyton
Mamelodi
Atteridgeville/Sausville
Alexandra
Kagiso
Lenasia
KwaZulu-Natal
Witsieshoek/Phutaditjhaba
Botshabelo
Mangaung
Thabong
Phoenix
Newlands East
Newlands West
Catsworth
Sydenham
Isipingo
Western Cape
Khayalitsha
Gugulethu
Langa
Cape Flats

North West
Ga Rankuwa
Winterveldt
Mapone
Limpopo
Mokerong
Thohoyandou
Seshego
Giyani
Mangeng

Northern Cape
Galeshewe
Other (specify)
How many Spaza shops does your company have business relationships with?*
(enter ‘0’ if none)
How many times per week is your company visiting Spaza shops to restock them?*
(enter ‘0’ if not restocking)
How many streetsellers does your company employ?*
(enter ‘0’ if not involved in street sales)
Describe briefly in which other ways you / your company is connected to the local community (please provide examples)?*

Reporting / Systems / Structure

Is your company willing to invest in IT systems to receive and print pin based airtime?*
What kind of secure warehouse facilities does your company have, in which to keep stock?*
In your company, do you have a:*
    General Manager* Yes No
    Administrator* Yes No
    Accountant* Yes No

Motivation

Describe briefly how you plan to push the sales of Telkom Mobile starter packs and airtime*
Please motivate why Telkom Mobile should choose you as one of their local distribution partners*
Any other comments you would like to share: