SOUTH AFRICA MATCHMAKING FORM

COMPANY INFORMATION:

Participant’s Name: ______

Title: ______

Company Name:______

Address:______

City: ______State: ______ZipCode: ______

Tel:______Cell:______Fax:______

E-mail: ______

Website:______

COMPANY PROFILE & MISSION STATEMENT

______

List Your Company’s Product(s) / Service(s): ______

MATCHMAKING INFORMATION:

Interested in (Please check all that apply):

[ ] Buying (Import) [ ] Selling (Export)

Markets (Please check all that apply):

[ ] Europe [ ] Africa [ ] Asia [ ] USA [ ] Canada [ ] Middle-East

[ ] Caribbean [ ] Latin America [ ] Other: ______

Areas of Interest:

[ ] Agent/Representative [ ] Wholesaler/Retailer [ ] Distributorship [ ] Memorandum of Understanding

[ ] Joint Venture / Partnership [ ] Franchising [ ] Other (specify):______

Please complete and return form to: Andrew Duffell ( or via fax 561-651-4136)