Card application
Full name/Company name:
____________________________________________
Card No: (for office use)
____________________________________________
Mobile number:
_______________________________________
Physical Address:
________________________________________
________________________________________
Email:__________________________________
Quantity of cards required __________
Cost of a card R 150.00
Monthly admin Fee R 20.00 on active cards only.
Signature Date
_________________ _________________________
Please print the application form and mail it to us with all the required information. It takes 10 working days to process and print the cards after the application has been received and payment has been confirmed: info@kiaranix.com