Application Type

Application New Client New User under an existing client

Personal Details

Registered Company Name (if applicable)

First Name

Last Name

Email

Confirm Email

Cell

Telephone

Fax

Preferred Pickup Location: -Preferred Pickup Location- Allee Bleue Cabriere Chamonix Dieu Donne Eikehof Franschhoek Cellar Grande Provence L'Ormarins La Motte Rickety Bridge Tokara Pam Golding Audacia Botrivier Minimark Hermanuspietersfontein Paul Cluver Waterkloof Bon Courage Clairvaux De Wetshof Nuwehoop (Uniwines) Overhex Rooiberg GEOSS Bellevue Leeuwenkuil Quoin Rock Villiera CDS - 09:00 CDS - 14:00 DGB - 09:00 DGB - 14:00 Laffort - 09:00 Laffort - 14:00 Perdeberg - 09:00 Perdeberg - 14:00 Windmeul - 09:00 Windmeul - 14:00

Preferred Communication:

Email SMS Fax

Physical Address

City/Town

Zip Code

Billing Information (if applicable)

VAT Number

Contact Person

Email

Confirm Email

Preferred Invoice Format:

Individual invoice (per sample) Grouped invoice

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Terms and Conditions

The results of tests will be handled with absolute confidentiality by Vinlab, however due to our status of Accredited Laboratory the results have to be made available to SANAS and other legal parties on request.

I hereby accept these terms and conditions