Intella Tread South Africa - A form requesting a floor treatment or demonstration

For further information, or a no-obligation, on-site demonstration and quotation from your closest IntellaTread licensee, please complete and submit the form below.

Your Information

Title :
First Name :	*
Last Name :	*
Company Name :
E-mail :
Telephone :
Facsimile :
Address :
Town / Suburb :
Postal Code :
Premises / company to be treated :
Areas to be treated :
Comments: Specific Questions: Concerns:
Please have a IntellaTread Licensee contact me to provide a demonstration and/or quotation . . .	Yes No
Please contact me to provide further info :	Yes No

Tel : +27 (0)31 573-1600
Fax :+27 (0)86 670 7694
E-mail : info@intellatread.co.za

89 Northway
Durban
South Africa
4051