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LIBSA Pledge Form
First Name:
Last Name:
Title:
Department:
Organization:
Street Address:
Phone:
City:
Code:
Fax:
Email:
Contribution Amount:
 

THANK YOU !

Make checks and money orders payable to:

Limpopo Business Support Agency
Private Bag X 9540, Polokwane, 0700
Zodwa Modika, Administration Officer

Make internet bank transfers payable to:


Account name: LIBSA
ABSA Bank
Branch: Polokwane
Branch code: 334 248
Account type: Cheque account
Account number: 404 967 9301
Reference: LIBSA Pledge and your name

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When submitting your personal or company details to LIBSA, the information will be kept confidential and not given or sold to any third party.


Copyright @ LIBSA 2009. All rights reserved