eJOB Agent Code (required) Contact Type (required) NewExisting Account No (required) Contact Entity (required) PersonalBusiness Business Name (required) Business VAT No (optional) Business Billing Address (optional) Primary Contact First Name (required) Primary Contact Last Name (required) Address for Deliveries (optional) When may we contact you (required) During Office HoursBetween 6am and 8amBetween 6pm and 8pmOther Other Contact Time (required) How should we contact you (required) Contact NumberE-Mail AddressOther Contact Number (required) May we WhatsApp you on this number? YesNo Contact E-Mail Address (required) Other Contact Method (required) > Job Date (required) Job Type (required) —Please choose an option—On-SiteWorkshopRemote SessionCollectionDeliveryOther Other Job Type Description (required) Travel (required) YesNo Vehicle Owner (required) CompanyPrivate Vehicle Registration (required) ODO Trip Start - KM (required) - Send picture to office Whatsapp ODO Trip Finish - KM (required) - Send picture to office Whatsapp Actual Distance Traveled - KM (required) External Charge Distance - KM (required) Labour (required) YesNo Labour Level (required) —Please choose an option—LAB-T0LAB-T1LAB-T2Other Other Labour Code Description(required) Teamwork (required) SoloTeam Specialists (required) Assistants (required) Actual Job Start Time HH:MM (required) Actual Job End Time HH:MM (required) Labour QTY - Hours (required) Tasks Completed (required) System Device Hardware Software Account Install Remove Upgrade Upload Download Update Maintain Optimize Backup Protect Connect Disconnect Link Unlink Transfer Restore Repair Replace Capture Transport Collect Deliver Other Items Supplied - CODE|QTY|SERIAL/S|AMT (if applicable) Payment Performed (required) YesNo Payment Amount (required) Payment Method (required) —Please choose an option—CashCardSnapEFTOther Other Payment Method Description (required) Document Upload (PDF ONLY) (Optional) By submitting this form, you accept our Terms and Conditions and acknowledge that NAXLAV (PTY) LTD and/or its representatives cannot be held liable for any data loss, physical loss, theft, damage, unforeseen damage, factors beyond our control and/or claim of any kind directly and/or indirectly. Please tick this box to accept our terms.