Text Box: Contact Person: Name & Surname: Cell No.: E-mail address: CC Registration Name: CC Registration Number: Number of active members: Would you like to make a name Change?: Please select your preferred speed for the conversion: *Please make the payment within 24hrs of submitting this form and fax or e-mail us your proof of payment so that we can proceed with your request. On receipt of proof of payment you will be sent a form which you will complete and fax or e-mail back to us.

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