ENERGY - BULK - OFFTAKER NG

PERSONAL DETAILS

Surname*

First Name*

Other Names

Mobile Number*

Age Group*

Gender*

Email Address*

Repeat Email Address*

BUSINESS DETAILS

You are ?*

Renewable Energy Producer / ManufacturerPetrochemical Trader
Petrochemical ManufacturerLicensed Oil Broker
RefineryOil and Gas Distributor
Licensed Energy TraderImporter
Licensed Energy Distributor

Is your business registered with the Corporate Affairs Commission?*

YES
NO

Is your business registered with the DPR?*

YES
NO

Do you have Export Experience?*

YES
NO

Have you undergone Africa House Export Training?*

YES
NO

Company / Business Name (If registered)

Company Number

TIN Number

Company / Business Address*

State*

Local Government Area*

City*

Business Email*

Repeat Business Email*

Business Phone

Business Website

PRODUCT SELECTION

Select your product:*

BiodieselSolar Energy Products
BiogasIndustrial Fuel
CharcoalNatural Gas
CoalOther Energy Related Products
Coal GasWood Pellets
Coke FuelSolar Energy Systems
Crude OilLubricant
Electricity GenerationDiesel Fuel
Petrochemical ProductsSolar Collectors

Describe your "ENERGY " product briefly (Max 50 characters)*

What quantity do you have to sell /supply*

2 - 10 tons
11 - 20 tons
21 - 50 tons
50 tons and Above

Frequency of Supply*

Daily
Monthly
Quarterly
Yearly

Product Packaging*

Drums
Tankers
IBC Tanks
Oil Tankers
Bulk Storage
Gas Tanker
Other

Payments Accepted

Local Bank Deposit (Registered Businesses Only)
Letter of Credit (Registered Businesses Only)
Cash On Delivery
Cash And Carry

Name of your Local Bank*

Local Bank Branch*

Current Location of Product*

Factory
Bulk Storage
Transit Terminal
Port
Tank Farm
Refinery

Can you Organize Transportation?*

Yes
Only within State
Only within City
No

TERMS AND CONDITIONS OF SERVICE*

1- I understand that registration does not imply automatic acceptance into the Offtaker Program. The decision to admit or reject a place is at the sole discretion of Africa House.

2-I agree to provide these personal and business information for official, administrative and any other uses allowed under the law by the Africa House, Webmaster and any other affiliated agencies or entities.

3-I agree that all information provided by me are true and accurate. Any false/misleading or misinformation may be used against me should legal matters arise as a result of such misleading information.

4-The Africa House, Webmaster and affiliated entities bears no form of legal or personal liability due to inaccurate or misleading information provided by the applicant.

5-Africa House reserves the right to request for more information and documentation in order to complete the process of admittance into the Offtaker Program, for the purposes of verifying the information provided during the application process.

6-Admittance into the Offtaker Program does not guarantee any form of financial rewards or benefits, neither does it guarantee your products would be purchased or offtaken by the Africa House, its affiliated agencies and partners.

7-The final decision to offtake or buy your products depends on a separate agreement between all the parties involved in the purchase or offtake process.

I agree