First Name:_Surname:_________

ID number: _________________________________________________

P.O. Box:________________Area:____________________Code:_______

Home Address:________________________________________________

____________________________________________________________

Current Occupation:____________________________________________

Contact Numbers: (W)_______________________________

(H)________________________________

(C)_______________________________

eMail:___________________________________________________

Reason for doing the Course:_________________________________________

________________________________________________________________

PAYMENTS METHODS

I would like to pay using the following method;

Credit Card.

NAME OF CARD HOLDER:____________________________________________

CARD NUMBER: __________ ___________ __________ _________

EXPIRY DATE: _________________

LAST 3 DIGITS ON THE STRIP (VERY IMPORTANT!) ___________________

IF BUDGET, HOW MANY MONTHS? ______________

SIGNATURE OF CARD HOLDER:________________________________________________

AMOUNT: R 4,546.00

BANK TRANSFER – Please arrange to transfer R4, 546.00

Natural Way Wholesalers

STANDARD BANK

Helderberg 033012

Acc # 071174974

Then fax the “Proof of Payment” slip with this form. Thanks!

021 856-2500

POST DATED CHEQUES – Enclose 3 cheques Made out to Natural Way Wholesalers for...

R 1,600.00 (Today’s date)

R 1,600.00 (Same date next month) and..

R 1,600.00 (Same date the month after that)

POST IT to us at PO Box 443, Gordon's Bay, 7151

On receipt of the order and cheques we will dispatch a complete course to you at the above address.

First Name:_______________Surname:_______________________

First Name:_Surname:_________