Company Name *

Company Registration Number (skip if buying club or bulk buying)

Delivery Address *

City *

Province *

Country *

Postal Code *

Company Phone Number *

Company Website *

Customer Type *
African StoreBuying ClubsCharityChef/FoodieDistributorFood BanksFood ServiceGrocersOnline StoresOtherRestaurantsRetail Outlets

Are you the legal owner? *
YesNo

Full Name*

Phone Number*

Email *

Consent *
I consent to Africanada Imports Inc. sending me relevant promotions, offers and information that may support my business. I understand that by NOT ticking the box I will NOT receive promotions brochure, special offers, rewards or personalised support and guidance via Email, SMS, Telephone or Mail.