Personal application

Name

Title First Last

Type of Identity Document

Identification / Passport Number

Date of Birth

Email Address

SA Residence Status (Permanent/Temporary)

Permanent
Temporary

SA Citizen (Yes/No)

Yes
No

Mobile Phone Number

Home Phone Number

Employer Details

Job Title

Work phone number

Marital Status

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

GPS Coordinate Latitude

GPS Coordinate Longitude

Postal Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Details of Required Installation

Installation address (If rural address, please provide lat & long details)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you the owner? (Alternatively,do you have written permission for the installation on the site?)

Yes
No
Written Permission for Installation

AC Power available?

Yes
No

Details of Selected Service Required

Unlimited 24 Month contract options:

4 Gen 5 Mbps down, 2 Mbps up
4 Gen 10 Mbps down, 3 Mbps up
4 Gen 20 Mbps down, 6 Mbps up

(All plans are subject to network best effort & fair use policies.)

Tick here to get a quotation first

Get a quotation

Tick here if you are ready to look at a contract

Ready to look at a contract

Additional information for the applicant:

Completion of this form carries no obligation. You will receive a formal contract to consider. Upon acceptance of the contract, the following documents will be required to process your application. If you wish you can upload them now to speed up the process:

Certified Copy of Identification

Individual: Certified copy of ID book (main page) - Certified copy of ID card (front and back) - Certified copy of passport

Proof of Address

Copy of utility bill or another bill traceable to source that contains both physical & postal customer addresses

Proof of Income/Funds

Individual: Salary slip - Bank letter to confirm funds - Bank statements (3 months)