Agent Partner Signup – Shop2Shop Agent Portal

Agent Partner Agreement

"*" indicates required fields

Full Name and Surname*

Shop Name*

Shop Code*

Physical Address*

House or Apartment Number Street Name Suburb Province Postal Code

ID / Permit number / Identity number / Passport number*

Country of origin*

Language*

Cell Number*

Email Address*

List Towns you Operate in*

eg. Bloemfontein, Windburg etc

Sales area*

Referral Partner*

Choose Shukran Shop Code*

Choose BrandDrive Shop Code*

Choose Shade Points Shop Code*

Choose Revgro Shop Code*

Referral Partner*

Referral Partner ShopCode*

Additional Email for Notifications

Upload proof of Address (No older than 3 months)*

Max. file size: 49 MB.