Civitas -

Join the Civitas waiting list

Please complete the form below and a Civitas team member will be in touch with you to discuss the next steps.

First Name

Last Name

Email Address*

Mobile Number*

What city are you based in?*

Cape Town

Durban

Johannesburg

Pretoria

Other

What is your LinkedIn profile URL?

How many years have you been self-employed?*

How many businesses have you founded or held the CEO title (including your current business)?

1

2

3+

Have you ever sold or acquired a business?

Yes

No

What was / is the annual revenue of the largest business or division you have ever managed?

Less than R1m

R1m to R5m

R5m to R20m

R20m to R50m

R50m to R100m

R100m to R250m

R250m to R500m

R500m to R1b

More than R1b

What is the largest team size that you have managed?

Never managed a team

1 to 10

11 to 20

21 to 50

50+

How do you manage your email and communication?

Same hour response

Same day response

Same week response

It varies

What is the name of your business?*

What is a one-line description of your business?*

What is the website address of your business?

Are you the founder of the business or directly responsible for all operations of the business?*

Yes

No

Are you working full or part-time on your business?*

Full-time

Part-time

Do you own more than 20% equity in the business*

Yes

No

What industry does your business operate within?*

Agriculture

Distribution / Logistics

Education

Events / Hospitality

Financial Services

FMCG

Manufacturing / Hardware

Marketing / Advertising

NPO

Property

Restaurants

Retail

Services

Tech

VC / Angel / Private Equity

What is your team size, including you?*

1 to 5

5 to 10

10 to 20

20 to 50

50 to 150

150 to 500

500+

How easy are you finding it to get customers?

Have not yet launched my business

Struggling to grow my customer base

Increasing monthly

Can't keep up with demand

What is the rough estimate of your annual revenue?*

Pre-revenue

R0 to R1m

R1m to R5m

R5m to R20m

R20m to R50m

R50m to R100m

R100m to R250m

R250m to R500m

R500m to R1b

More than R1b

What was your previous year's revenue growth?*

Less than a year old

Did not grow

1 to 10%

11 to 30%

31 to 50%

51 to 100%

101 to 300%

301% or more

Have you raised funding for your business? If so, how much?

What is the maximum annual revenue you believe your business can achieve?

More than R1m per annum

More than R10m per annum

More than R100m per annum

More than R1b per annum

When would you like to get going with Civitas?*

As soon as possible

3 months

6 months

Next year