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Step 1 of 6 - Business Information

URL

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Section 1: Business Information

UUID

Submission Date*

Name of business*

Business entity*

To ensure we assign the correct Area Business Consultant to your account, please select your consultant from the list below:*

(If you're unsure, please choose the region closest to your business location)

Business owner's ID document*

Accepted file types: jpg, png, pdf, Max. file size: 5 MB.

CK documents*

Please upload the company registration forms

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 5 MB.

Business owners' ID documents*

Please upload all the business owners' ID documents

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 5 MB.

Business owner first name*

Business owner surname*

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Business owner full name*

Identity number of business owner*

Email address of applicant*

Year business established*

Practice number*

Telephone number*

Fax number*

Alternate contact number*

Cellphone number (for marketing purposes)*

VAT number*

Email address (newsletters/marketing)*

Email address (accounts)*

Contact person (accounts)*

Delivery address*

Street Address Address Line 2 City Province Postal Code Country

Billing address

My billing address is different from my delivery address

Billing address*

Street Address Address Line 2 City Province Postal Code Country

Section 2: E-Commerce Details

Do you have an e-commerce store?*

Yes

Does your online store operate under the same business entity*

Yes

Online store details

Name of business*

Contact person*

Business entity*

Business owner's ID document*

Accepted file types: jpg, png, pdf, Max. file size: 5 MB.

CK documents*

Please upload the company registration forms

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 5 MB.

Business owners' ID documents*

Please upload all the business owners' ID documents

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 5 MB.

Year business established*

Telephone number*

Alternate contact number*

Cellphone number*

Email address*

VAT number*

Delivery address*

Street Address Address Line 2 City Province Postal Code Country

Section 3: Clinic Listing

Would you like to be listed on our website under our Clinic Locator?*

Yes

Name of clinic (trading name)*

Street address of clinic*

Street Address Address Line 2 City Province Postal Code Country

Contact number of clinic*

Website address (if applicable)

Section 6: Terms and Signature

Terms and Conditions

Scroll to read more.

1. Payment

Payments are to be made to Dermafrica (PTY) Ltd via Electronic Funds Transfer (EFT)payment. Payment confirmation/proof of payment must be forwarded by Purchaser to accounts@dermafrica.com. No parcel will be dispatched without a proof of payment. Dermafrica also has the right to only dispatch the parcel one the funds reflect in our bank account.

Banking Details:
Account Name: Dermafrica (PTY)LTD
Bank: Absa Bank
Branch Code: 632005
Account Number: 4062926214
Reference: Use your allocated Dermafrica (PTY)LTD account number as reference when making payment to the account.

2. Orders, Shipment, and Delivery

Orders must be placed using the company order form and emailed to orders@dermafrica.com.
Orders will not be processed or delivered on public holidays or during specified closing periods. Clients will be notified in advance.
Delivery services include same-day, next-morning, or economy service.
Same-day delivery is available upon request; contact Dermafrica CC for details.
Orders take 48 hours to process. Place orders in advance to avoid delays.
Deliveries are generally dispatched the following morning, with 24–48 hours for main areas and 48–72 hours for outlying areas.
Courier fees vary based on the delivery address, with additional fees for outlying areas. Contact Dermafrica CC for details.
For “payment in advance” accounts, payment confirmation must be received by 14:30 to ensure same-day dispatch.
Orders not confirmed within five (5) working days will be canceled.
Signed delivery notes confirm receipt of goods in good condition.
Free delivery fees are subject to the supplier’s price list, reviewed annually

3. Responsibility for Orders, Warranties, and Product Use

Responsibility for orders passes to the Purchaser upon delivery.
All items are subject to manufacturer warranties. Dermafrica CC is not liable for indirect or consequential losses.
Purchasers must use consent and diagnosis forms provided by Dermafrica CC for all treatments.
Dermafrica CC will not assist in cases without completed forms.
Dermafrica CC may cancel agreements and reclaim products if products are negligently prescribed or administered.

4. Distribution

Purchasers may not sub-distribute products.
Online sales require additional authorization documentation.
Agreements cover physical product and treatment sales only.
Business ownership changes require a new agreement.
Purchasers agree not to source products from unauthorized distributors.
E-commerce campaigns are restricted to South Africa.

5. Product Complaints

Complaints must follow this protocol:

Notify Dermafrica CC within 48 hours of receiving goods.
Inform the area representative.
Complete and submit a Complaint Form to info@dermafrica.com.
For treatment-related complaints, submit the following:
- Complaint Form
- Patient Consent Form
- Patient Diagnosis Form
- iHigh-quality photographs (before and after treatment). Ensure client consent is obtained.
Meet all form requirements.
Replacement of products is at Dermafrica CC’s discretion.

6. Training

Employees must attend product training annually.
Training costs are borne by the Purchaser.
Failure to train employees may result in a suspension of sales.

7. Advertising

Only approved materials may be used for advertising.
Marketing materials remain the property of Dermafrica CC. Damaged materials will be charged to the Purchaser.
Testers and samples are for marketing purposes only and cannot be sold.
Advertising must be pre-approved by Dermafrica CC.
Group buying or social platform campaigns require approval.
Purchasers may not alter Dermafrica CC’s artwork.
Only approved goods (per Annexure A) may be sold online.
Violations of clause 8.7 require corrective action within 72 hours.
Failure to remedy violations may result in agreement termination.
Purchasers must not harm Dermafrica CC’s reputation.

8. Treatment Protocols

Protocols provided with products must be followed.
Purchasers must explain treatment risks and benefits to clients.
Clients must receive full support and after-sales service.
Suggested Packages should be offered where appropriate to ensure protocol adherence.

9. Consent

I / We do hereby warrant that all the information recorded in this application is true and correct, that I / We sign of my / own free will and with the full knowledge and understanding of the contents hereon and that I / We are duly authorized in doing so.
I / We undertake to abide by the credit terms offered by the Company and recognize the full responsibility of this commitment.
The Applicant specifically consent that the Company, its agent or representatives:
- May carry out a credit enquiry in respect of the Applicant;
- May access the data base of any Risk Information Agency before granting credit to the Applicant;
- May where credit is granted, transmit details to a Risk Information Agency of how the Applicant has performed in meeting its obligations under the account, and share such information with other Risk Information Agencies for purposes of assessing further application for credit by the Applicant (and its members, directors, trustees or partners as the case may be) and for occasional debt tracing, debt collection and fraud prevention purposes;
- If credit is granted in favour of the Applicant and the Applicant fails to meet its financial commitments to the Company, the Company may record the Applicant’s default with a Risk Information Agency;
- May record the existence of an account with the Applicant at a Risk Information Agency;

10. Recovery of legal /collection costs

Should Dermafrica instruct its attorneys or collection agent to collect any overdue amounts, or to take any action against THE APPLICANT in the implementation or protection of Dermafrica’s rights, Dermafrica shall be entitled to the recovery of all legal or collection costs arising there from, on the scale as between attorney, agent or collection agency and own client.

11. Change of address

THE APPLICANT undertakes to notify Dermafrica in writing within 7 (seven) days of any change of address

12. Withdrawal of credit facilities

The Customer acknowledges that the Company shall be entitled, at any time, in its sole and absolute discretion, and without prior notice and without ascribing any reason therefore, to withdraw any credit facilities granted by it to the Customer, whereupon all amounts due by the Customer to the Company shall immediately be and become due and payable. Without derogating
- fails to provide the Company with such security as the Company may in its sole discretion deem necessary; and/or
- exceeds the credit limit agreed and approved for the Customer between the Company and its insurers. In such instances the
  Company shall be entitled to withdraw or reduce the Customer’s credit until such time as the Customer brings his account within the
  agreed credit limit.

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Full Name*

Signature*

Signature Date*

Apply for Account

Section 1: Business Information

Section 2: E-Commerce Details

Online store details

Section 3: Clinic Listing

Section 4: Medical Practitioner Details

Section 5: Product Sign-Up

Section 6: Terms and Signature

Terms and Conditions

1. Payment

2. Orders, Shipment, and Delivery

3. Responsibility for Orders, Warranties, and Product Use

4. Distribution

5. Product Complaints

6. Training

7. Advertising

8. Treatment Protocols

9. Consent

10. Recovery of legal /collection costs

11. Change of address

12. Withdrawal of credit facilities

Apply for Account

Section 1: Business Information

Section 2: E-Commerce Details

Online store details

Section 3: Clinic Listing

Section 4: Medical Practitioner Details

Section 5: Product Sign-Up

Section 6: Terms and Signature

Terms and Conditions

1. Payment

2. Orders, Shipment, and Delivery

3. Responsibility for Orders, Warranties, and Product Use

4. Distribution

5. Product Complaints

6. Training

7. Advertising

8. Treatment Protocols

9. Consent

10. Recovery of legal /collection costs

11. Change of address

12. Withdrawal of credit facilities

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