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Technical issues due to Loadshedding

Please use the 060 961 7882 if you cannot get through on the landline due to load shedding.

Register as a Client

The Couch 

 Physical Address: 40 River Road
Office Phone Number: 011 234 0741
Mobile Phone Number: 071 682 7107
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

All details are Strictly Confidential

Client Details

Please let us know your name.

Your First Names

Please let us know your Surname

Your Surname

Contact Details

Please Let us Know your Home Phone Number.

Home Telephone Number

Please Let us Know your Cel Phone Number.

Cell Phone Number

Please Let us Know your Work Phone Number.

Work Telephone Number

Please let us know your email address.

Your Email Address This will also be used to register you on our website.

Please supply your ID Number

Your ID Number

Please tell us your Date of Birth

Your Date of Birth

Terms and Conditions

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