LIBSA - LIMPOPO BUSINESS SUPPORT AGENCY

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

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

	LIBSA Pledge Form
	Date:
	First Name:
	Last Name:
	Title:
	Department:
	Organization:
	Street Address:
	Phone:
	City:
	Code:

	Cell Phone:
	Fax:
	Email:

	Contribution Amount: