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Wireless Signup Form
Please complete the application form below and we will get you online as soon as possible.
If you are human, leave this field blank.
Name
*
Surname
*
Id Number
*
Email Address
*
Phone Number
*
Alternative Phone Number
Installation Address
*
Billing Address
*
Package Required
*
Package Required
4 Mbps Wireless - R633 pm
6 Mbps Wireless - R748 pm
8 Mbps Wireless - R899 pm
10 Mbps Wireless - R1093 pm
20 Mbps Wireless - R1783 pm
Contact Term Options
*
Contact Term Options
Month to Month - Installation cost dependant on equipment
12 Months - Installation cost dependant on equipment
24 Months - Installation cost dependant on equipment
Accept Terms And Conditions (View Below)
*
Accept Terms And Conditions (View Below)
Yes
No
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