Your Name (required)
Your Surname (required)
ID Number (required)
Mobile (required)
Landline
Your Email (required)
Package (required) ---FTTH 5 Mbps Link (Uncapped)=R 499.00 /mFTTH 10 Mbps Link (Uncapped)=R 699.00 /mFTTH 25 Mbps Link (Uncapped)=R 989.00/mFTTH 50 Mbps Link (Uncapped)=R 1 384.00 /mFTTH 100 Mbps Link (Uncapped)=R 2 036.00 /mFTTH 200 Mbps Link (Uncapped)=R 2 900.00 /m
Installation Address (required)
Do you have a Termination Point (required) YES - No Installation fee requiredNO - Installation fee of R862.50 required
Suburb name (required)
Province (required)
Postal code (required)
Name of account holder (required)
Bank (required)
Account number (required)
Branch name (required)
Branch number
Debit Order Date/EFT (required) EFT1st15th25th26th31st
Account type (required) ChequeSavingsTransmission
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