Order Form Please enable JavaScript in your browser to complete this form.Referred By (or sale rep name)DateWhich Province Do You StayOtherGautengNorth WestFreestateKwazulu-NatalEastern CapeNorthern CapeWestern CapeLimpopoMpumulangaCompany NameFirst Name *Surname *Cellphone Number *Email Address *Electronic MagazineNoneElectronic Magazine upto 5 pages - R500Electronic Magazine upto 10 pages - R900Electronic Magazine 11+ pages - RTBCMagazine and Social Media Advertising (Advert)NoneBusiness Card Advert - R100Quarter Page Advert - R300Half Page Advert - R450Full Page Advert - R795Front Page Advert - R1000Other Options - RTBCExtra NotesI hereby accept that the above is correct and confirm that I agree to the Standard Terms and Conditions List. Full terms and conditions list is available on the website www.komena.com E&OE. Cash or Electronic Transfer will be accepted (No Cheques). Once this contract is signed it is taken that you have accepted everything and is binding and will not cancel by any method whatsoever. If clients wish to cancel they have to give a 2 calender month written notice of such and the balance of the contract can either be transferred or forfeited. No refunds will be given unless approved by our office in writingNoYesCommentSubmit