Title

Name and Surname *

Phone Number *

ID Number/Passport Number *

Products(Contention Ratio do apply on all internet packages) *
Up to 2Mbps @R250p/m (5:1)Up to 5Mbps @R350p/m (10:1)Up to 10Mbps @R450p/m (10:1)Up to 20Mbps @R250p/m (20:1)Up to 50Mbps @R850p/m (25:1)Up to 10Mbps @R1050p/m (50:1)VoIP Phone @Variable prices per set

Billing Agreement *
 Month to Month – Once off Installation fee worth R250024 Months contract – Free Installation and setup fee(only apply to all fibre packages and 10Mbps wireless packages and more)

Payment Method *
 Debit Order(Use and pay option)payment are debited on a selected debit dateDirect Deposit(Pay as you use option)payments are due two days after service activation)

Banking Details

Debit order/Payment date *
 1st15th25th27thlast day of the month

By typing in your name in the box below, you Electronically sign and agree to the Electronic order, Credit Order, Direct deposit Mandate *