Email*

Email*

First Name

First Name

Last Name

Last Name

Store Name*

Store Name*

https://myunico.co.za/store/[your_store]

Gender*

Gender*Select Male Female

Year of study?*

Year of study?*Select 1st year 2nd year 3rd year 4th year Postgrad

Student number*

Student number*

Campus*

Campus*Select Howard College Edgewood Westville PMB

Product Catalog document*

Product Catalog document*

Select the campus where your products can be delivered*

Select the campus where your products can be delivered*Edgewood Howard Westville PMB

How do you plan to deliver on the selected campus(es)?*

How do you plan to deliver on the selected campus(es)?*

Proof of registration*

Proof of registration*

ID copy*

ID copy*

Picture of the student card*

Picture of the student card*

Password*

Password*

Confirm Password*

Confirm Password*

* Agree  Terms & Conditions