CUSTOMER REGISTRATION FORM
*
indicates required
Name:
Email:
Comment:
Email Address
*
e.g. john.blue@gmail.com
First Name/ Company Name
*
Last Name
Telephone number
*
e.g. +256 771 234567
Home Address
*
Office Address
*
Next Of Kin Name
*
Next of Kin Telephone Number
*
Recommender
*
How did you learn about Spe?
Spe Account Type
Corporate account
Individual account
