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JJKhoza Tech Customer Information Application*Test* Form

Office Use Only

Customer Reference

Date of Application Processing

Service Classification

Service Classification

Sales Agent Name

Sales Agent Phone


Personal/Company Information

Type of Organization

Type of Organization
A
B
C
D

Service Required

Service Required
A
B
C
D
E
F
G
H
I
J
K
L
M
N

Sign here(signature of client)

Signature
📌12 Harding Street Shop No:6, Newcastle, KwaZulu Natal, South Africa
📞061 529 5008
JJKHOZATECH PTY LTD

Thank You For Your Information