Businesses to Run from Home

							                            Roodekrans Neighbourhood Watch
                               Business Membership Form
                        N.B. Only one form is required per business address
                For a crime free neighbourhood don't respond to crime, prevent it

                                                     Physical Address:
Street Name                                                                  Street No.
Shopping Centre                                                              Route

                                                     Business Details:
Business Name                                              Trading Name
Business Type
Business Hours Weekdays                                    Weekends & Public Holidays
Business Telephone No.                                     Emergency Telephone No
Business Email Add                                         Business Website

                                Proprietor / Member / Director / Executive Officer
Owners Name                                                Surname
Cellular                                                   Home
Work                                                       Email
Birth Date                                                 ID No.

                                            Manager / Alternate Contact Details
Managers Name                                              Surname
Cellular                                                   Home
Work                                                       Email
Birth Date                                                 ID No.

                                                           Participation
If you or your staff would like to participate in any of the following, please tick the appropriate box:
        Shopping Centre Representatives                      Use of Facilities
        Marketing                                            Foot Patrols
        Recruiting                                           Car Patrols
        Other

                                                   Security Company, if any
       ADT          Chubb        Thompsons                 Lexus              Dowry
       Other

                                            Membership Categories & Fees
                   Payable by Internet Payments, Electronic Transfers, Cheque, Cash or Bank Deposit
                                                        Entrance Fee Monthly Fee         or
       Full Membership                                          R 100           R 60
       Full Membership (Existing Home Member)                      R0           R 30
       Shopping Centre Membership                               R 100           R 30
       Shopping Centre (Existing Home Member)                      R0             R0
       Associates/Partners/ Sponsors                               R0             R0
       Entrepreneurial                                               R 100            R 60
       Entrepreneurial (Existing Home Member)                          R0              R0
       Honorary                                                        R0              R0
                                                   Banking Details

Bank: First National Bank                 Branch: Johannesburg          Account Type: Cheque Account
Account Number: 6213 0799 549             Branch Code: 251305
Note: Please fax or email proof of payment to Cor Boer. The fax number is 011 475 7215 and email address
cor@beekboer.co.za.
The "Business Name" should be used as the payment reference.

                                Information, Indemnity, Signage and Signature
All information will be treated with confidentiality, and will be used by the Roodekrans Neighbourhood Watch only.
You are not obliged to provide any information that you do not want to.
The member hereby waives any action it may hold against the Neighbourhood Watch howsoever arising
from participation in Neighbourhood Watch activities.
On payment of your entrance fee, you will be supplied with a signboard reflecting your membership of the
Neighbourhood Watch. The sign remains the property of the Neighbourhood Watch and upon termination of your
membership for any cause whatsoever, you herewith authorise the Neighbourhood Watch or any duly authorised
representative to remove the sign from your premises.

By signing this document you acknowledge that you have read and understood the contents hereof.

Signature:___________________________________                          Date:_________________

Signature:___________________________________                          Date:_________________

                                      Submission of Completed Application
The completed membership form will be collected by Wendy Whitehorn. Contact number: 082 900 4540.

                                              Additional Information

                                  Brief Description of Membership Categories
Full Membership                                         Business falls within the geographical area of the RNW and
                                                        will benefit from the patrols and other Business Watch activities
Full Membership (Existing Home Member)                  As above with rate benefits.
Shopping Centre Membership                              100% of tenants of shopping centre become members.
                                                        Benefits the same as full members but include reduced rates
Shopping Centre (Existing Home Member)                  As above with rate benefits.
Associates/Partners/ Sponsors                           Local or outside business providing discounted rates to
                                                        the Roodekrans Neighbourhood Watch and its members
                                                        and thereby enhance the work of the Neighbourhood Watch
Entrepreneurial                                         Businesses run from residential premises in RNW
                                                        geographical area. Benefits the same as for full membership.
Entrepreneurial (Existing Home Member)                  As above with rate benefits.
Honorary                                                A local or outside business with clients in our area that
                                                        provides FREE services or significant sponsorships,
                                                        i.e. in excess of R1000 pa, to the RNW or its members
                                             More Information
For more information please contact Wendy Whitehorn:                   Tel:          082 900 4540
       Web:      www.roodekranswatch.org             Email             roodekransblockwatch@gmail.com
Officer




ppropriate box:
              Victim Support
              Trauma Counselling




sh or Bank Deposit
                     Annual Fee
                                  R 600
                                  R 300
                                  R 300
                                    R0
                                    R0
                                  R 600
                                    R0
                                    R0
    Cheque Account

7215 and email address



 ature
ans Neighbourhood Watch only.

 h howsoever arising

our membership of the
 and upon termination of your
 Watch or any duly authorised


contents hereof.

_____________

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n
umber: 082 900 4540.




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     082 900 4540
 blockwatch@gmail.com