HEALTH & MEDICAL - OFFTAKER NG

PERSONAL DETAILS

Surname*

First Name*

Other Names

Mobile Number*

Age Group*

Gender*

Email Address*

Repeat Email Address*

BUSINESS DETAILS

You are:*

Producer / ManufacturerDistributor
Middle-Man (Broker)Manufacturer's Agent
ResellerImporter

Is your business registered with the Corporate Affairs Commission?*

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:*

Animal ExtractEquipments of Traditional Chinese Medicine
Plant ExtractsGeneral Assay & Diagnostic Apparatuses
Body WeightMedical Consumable
Health Care SupplementMedical Cryogenic Equipments
Health Care SuppliesMedical Software
Crude MedicinePhysical Therapy Equipments
Prepared Drugs In PiecesRadiology Equipment & Accessories
Traditional Patented MedicinesSterilization Equipments
Body Fluid-Processing & Circulation DevicesSurgical Instrument
Clinical Analytical InstrumentsUltrasonic, Optical, Electronic Equipment
Dental EquipmentWard Nursing Equipments
Emergency & Clinics ApparatusesMedicines

Describe your "HEALTH & MEDICAL " product briefly (Max 50 characters)*

What quantity do you have to sell /supply*

0 - 1kg
1kg - 50kg
50kg - 200kg
200kg - 500kg
500kg - 1 ton

Frequency of Supply*

Daily
Monthly
Quarterly
Yearly

Product Packaging*

Boxes
Cartons
Pouches
Sachet
Bottles (PET ,Glass)

Payments Accepted

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

Current Location of Product*

Own Storage
Third Party Storage
Under Production
Already in Market

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