window.ALTCHA_CHALLENGE_URL = "https:\/\/altcha.bravenet.com\/challenge";
(function() { var url = "https:\/\/altcha.bravenet.com\/challenge"; if (typeof jQuery !== 'undefined' && jQuery('.bnet-form').length) { jQuery('.bnet-form').attr('data-altcha-challenge-url', url); } else if (typeof $BN !== 'undefined' && $BN('.bnet-form').length) { $BN('.bnet-form').attr('data-altcha-challenge-url', url); } })();
if (typeof global !== 'undefined') { global.ALTCHA_CHALLENGE_URL = "https:\/\/altcha.bravenet.com\/challenge"; }
(function() { var url = "https:\/\/altcha.bravenet.com\/challenge"; if (!window.ALTCHA_CHALLENGE_URL) { window.ALTCHA_CHALLENGE_URL = url; } })();
document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub27.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=2285354722&formid=3730&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:2285354722:27:3730\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Wowos Club Shareholders (WCS)</div></div> <div class=\"bn-form-desc\"><p>This is an e-contract that the investor signs in order to be accepted to the Wowos Club Shareholders (WCS), a cohort of Wowos Club PTY LTD (Reg. No.: 2016/544511/07). By submitting this contract the investor acknowledges that they have read all the documentations accompanying the contract available in various platforms including the WhatsApp group associated with the WCS. ');
document.write('');
document.write('I acknowledges that I have read the terms and conditions of the WCS and bind myself to them. The money will be paid electronically (EFT) to the account that I have supplied below. I will commit to this initiative and inform the group in time if I intend resigning from the scheme as stated in the WCS terms and conditions. In case of death or any disabilities that may inhibit WCS to reach me in order to pay out the monies due to me, I request that my beneficiary be contacted so that the money can be paid out to him/her.</p></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Full Names and Surname <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"your first and last name\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Email Address <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"you must enter a valid email address\" validator=\"email\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Mobile Number <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-154982339730266\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Alternative Number </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-154982342202296\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">What is the total number of shares you are buying?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-154982353539841\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">What is the total number of shares you are selling?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1764536386726103\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Account Holder Name <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-154982361502485\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Account Number <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-154982367966964\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Name of the Bank <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-1549823665314101[]\" required=\"required\"><option value=\"Absa\" selected=\"\">Absa</option><option value=\"Capitec\">Capitec</option><option value=\"FNB\">FNB</option><option value=\"Nedbank\">Nedbank</option><option value=\"Standard Bank\">Standard Bank</option></select></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Beneficiary Names and Surnames <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-154982375862029\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Contact Details of the Beneficiary <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-154982382466978\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Relationship with Beneficiary <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154982410212171[]\" value=\"Spouse (Wife/Husband)\" required=\"required\"> <span class=\"bn-inner-label\">Spouse (Wife/Husband)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154982410212171[]\" value=\"Child \" required=\"required\"> <span class=\"bn-inner-label\">Child </span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154982410212171[]\" value=\"Sibling (Sister/Brother)\" required=\"required\"> <span class=\"bn-inner-label\">Sibling (Sister/Brother)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154982410212171[]\" value=\"Parent (Father/Mother)\" required=\"required\"> <span class=\"bn-inner-label\">Parent (Father/Mother)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154982410212171[]\" value=\"Other\" required=\"required\"> <span class=\"bn-inner-label\">Other</span></label></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">How did you hear about it?  </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-154982420023129\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Should we add you in Wowos Shareholders Club on WhatsApp?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-1549824245634105\" value=\"Yes\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-1549824245634105\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Should we add you in Wowos Club Newsletter?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-164064222711430\" value=\"Yes\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-164064222711430\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Do you acknowledge all terms and conditions of this e-contract?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-154982430901827\" value=\"Yes\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-154982430901827\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"Thank you for your form submission\"> <input type=\"hidden\" name=\"subject\" value=\"Wowos Club Shareholders (WCS)\"><div class=\"bn-form-submit\"><button type=\"submit\" class=\"formbtn\">Submit Form</button></div> <style type=\"text/css\">.bnet-form ::-webkit-input-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form ::-moz-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form :-ms-input-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form :-moz-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bn-form-legend, .bn-form-legend div {');
document.write('      font-size:23px;');
document.write('      font-family:Arial, Helvetica, sans-serif;');
document.write('      color:#000000;');
document.write('}');
document.write('.bn-form-desc {');
document.write('	  font-size:15px;');
document.write('    font-family:Arial, Helvetica, sans-serif;');
document.write('    color:#222222;');
document.write('}');
document.write('#the-form, .bnet-form, .form-wrapper, .bn-form-preview, .bn-thankyou-msg {');
document.write('     background-color:#ffffff;');
document.write('}');
document.write('.bn-form-submit .formbtn {');
document.write('	 font-size:15px!important;');
document.write('      font-family:Arial, Helvetica, sans-serif!important;');
document.write('      color:#ffffff!important;');
document.write('      border-radius:7px!important;');
document.write('      background-color:#474747!important;');
document.write('}');
document.write('.bn-label {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000!important;');
document.write('}');
document.write('.bn-thankyou-msg, .bn-form-preview {');
document.write('   font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('}');
document.write('.bn-response {');
document.write('  color:#000000;');
document.write('}');
document.write('.bn-input input[type=text], .bn-input textarea {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	border-radius:5px;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('}');
document.write('.bn-select {');
document.write('	border-style:solid;display:inline-block;width:100%;overflow:hidden;box-sizing:borderbox;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('	border-radius:5px;');
document.write('}');
document.write('.bn-select select {');
document.write('  box-sizing:borderbox;');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	background-color:#ffffff;');
document.write('	border:0;');
document.write('}');
document.write('.bn-input label.bn-radio, .bn-input label.bn-checkbox {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000!important;');
document.write('}');
document.write('.bn-radio input, .bn-checkbox input {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	border-radius:5px;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('	display: none;');
document.write('}');
document.write('label.bn-checkbox, label.bn-radio {');
document.write('  position: relative;');
document.write('  padding-left: 36px;');
document.write('  line-height: 32px;');
document.write('}');
document.write('label.bn-checkbox span.bn-inner-label:before, label.bn-radio span.bn-inner-label:before,');
document.write('label.bn-checkbox span.bn-inner-label:after, label.bn-radio span.bn-inner-label:after {');
document.write('  font-family: \'Material Icons\';');
document.write('  text-rendering: optimizeLegibility;');
document.write('  font-feature-settings: \"liga\" 1;');
document.write('  font-style: normal;');
document.write('  text-transform: none;');
document.write('  line-height: 32px;');
document.write('  font-size: 32px;');
document.write('  width: 32px;');
document.write('  height: 32px;');
document.write('  text-align: center;');
document.write('  top: 0px;');
document.write('  left: 0px;');
document.write('  display: inline-block;');
document.write('  overflow: hidden;');
document.write('  -webkit-font-smoothing: antialiased;');
document.write('  -moz-osx-font-smoothing: grayscale;');
document.write('  transition: all .2s;');
document.write('  color: #ccc;');
document.write('  color:#cccccc;');
document.write('  position: absolute;');
document.write('}');
document.write('label.bn-radio span.bn-inner-label:before {');
document.write('  background: -moz-radial-gradient(center, ellipse cover,#ffffff 0px,#ffffff 9px,rgba(0,0,0,0) 14px,rgba(0,0,0,0) 100%);');
document.write('  background: -webkit-radial-gradient(center, ellipse cover, #ffffff 0px,#ffffff 9px,rgba(0,0,0,0) 14px,rgba(0,0,0,0) 100%);');
document.write('  background: radial-gradient(ellipse at center, #ffffff 0px,#ffffff 9px,rgba(0,0,0,0) 14px,rgba(0,0,0,0) 100%);');
document.write('}');
document.write('label.bn-checkbox span.bn-inner-label:before {');
document.write('  background: -moz-radial-gradient(left,rgba(255,255,255,0) 0px,rgba(255,255,255,0) 5px,#ffffff 5px,#ffffff 27px, rgba(0,0,0,0) 26px,rgba(0,0,0,0) 100%);');
document.write('  background: -webkit-radial-gradient(left, rgba(255,255,255,0) 0px,rgba(255,255,255,0) 5px,#ffffff 5px,#ffffff 27px, rgba(0,0,0,0) 26px,rgba(0,0,0,0) 100%);');
document.write('  background: linear-gradient(to right, rgba(255,255,255,0) 0px,rgba(255,255,255,0) 5px,#ffffff 5px,#ffffff 27px, rgba(0,0,0,0) 26px,rgba(0,0,0,0) 100%);');
document.write('  background-size: 28px 21px;');
document.write('  background-repeat: no-repeat;');
document.write('  background-position-y: 5px;');
document.write('}');
document.write('label.bn-checkbox span.bn-inner-label:before  {');
document.write('  content: \'check_box_outline_blank\';');
document.write('}');
document.write('label.bn-radio  span.bn-inner-label:before {');
document.write('  content: \'radio_button_unchecked\';');
document.write('}');
document.write('input[type=checkbox]:checked + span.bn-inner-label:before, input[type=radio]:checked + span.bn-inner-label:before {');
document.write('  opacity: 0;');
document.write('}');
document.write('input[type=checkbox] + span.bn-inner-label:after {');
document.write('  content: \'check_box\';');
document.write('  color:#2696f9;');
document.write('  color:#2696f9;');
document.write('}');
document.write('');
document.write('input[type=radio] + span.bn-inner-label:after {');
document.write('  content: \'radio_button_checked\';');
document.write('  color:#2696f9;');
document.write('  color:#2696f9;');
document.write('}');
document.write('input[type=radio]:not(:checked) + span.bn-inner-label:after,');
document.write('input[type=checkbox]:not(:checked) + span.bn-inner-label:after {');
document.write('  opacity: 0;');
document.write('  transform: scale(.3);');
document.write('}');
document.write('');
document.write('input[type=radio]:checked + span.bn-inner-label:after,');
document.write('input[type=checkbox]:checked + span.bn-inner-label:after {');
document.write('  opacity: 1;');
document.write('  transform: scale(1);');
document.write('}');
document.write('.bn-date-input {');
document.write('  position: relative;');
document.write('}');
document.write('.bn-date-input .bn-date-pick {');
document.write('  position: absolute;');
document.write('  width: 24px;');
document.write('  height: 24px;');
document.write('  font-size: 24px;');
document.write('  right: 5px;');
document.write('  top: 50%;');
document.write('  margin-top: -13px;');
document.write('');
document.write('}');
document.write('.bn-date-input .bn-date-pick {');
document.write('  color: #000;');
document.write('  color:#c4c4c4;');
document.write('  opacity: 0.75;');
document.write('}</style></form>');