FIBRE TO ALRODE FORM Alrode Business By filling in the below form, you are confirming consent to your personal data being processed for the Solid Fibre order form purpose as described below. Please make sure all required fields are filled in. Required fields are marked with an asterix. (*) NAME * NAME First First Last Last EMAIL (TO BE USED FOR BILLING PURPOSES) * PHONE * ADDRESS FOR FIBRE TO BE ACTIVATED * ADDRESS FOR FIBRE TO BE ACTIVATED ADDRESS FOR FIBRE TO BE ACTIVATED ADDRESS FOR FIBRE TO BE ACTIVATED City City State/Province State/Province Zip/Postal Zip/Postal Please select a package option from our 12 month or 24 month contract options. FTTB - 12 month contracts 10 Mbps 12 Months - R 1799 20 Mbps 12 Months - R 2499 50 Mbps 12 Months - R 5499 100 Mbps 12 Months - R 9299 FTTB - 24 month contracts 10 Mbps 24 Months - R 1599 20 Mbps 24 Months - R 2299 50 Mbps 24 Months - R 5299 100 Mbps 24 Months - R 8799 PLEASE NOTE: Setup includes one point of connectivity. Any additional points to increase connectivity will be an additional cost and quoted accordingly. FIBRE SETUP - for the first 25m. Additional Setup Rate R140.00 per metre afterwards R3500 Once-off Setup R1400 x 3 month payment WIRELESS SETUP 10 Mbps 12 Months - R 1799 10 Mbps 24 Months - R 1599 20 Mbps 12 Months - R 2499 20 Mbps 24 Months - R 2299 WIRELESS SETUP R1499 Once-off Setup BUSINESS VOICE SOLUTIONS - SIP TRUNK OPTIONS 1 to 4 Channel Sip Trunk - R 299 PM 5 to 8 Channel Sip Trunk - R 499 PM 8 to 16 Channel Sip Trunk - R 899 PM SETUP R350 Once-off Setup PORTING R399 Once-off Setup - porting per number HOSTED SERVICES R 299 PM HOSTED PBX R 75 PM HOSTED EXTENSION MESSAGE We as a company, would advise our customers to sign up with our Debit order facility. The Debit order simplifies the billing process. If you select the EFT option. Please note we will charge an additional R50.00 per month for Administration purposes. If payment has not been received by the 1st of the billing month, your account will be suspended and once payment has been received, we will charge you a reconnection fee of R80.00. In a case where your debit order bounces the, reconnection fee will apply. PAYMENT OPTIONS * DEBIT ORDER FACILITY EFT (ELECTRONIC FUNDS TRANSFER) BILLING ADDRESS * BILLING ADDRESS BILLING ADDRESS BILLING ADDRESS City City State/Province State/Province Zip/Postal Zip/Postal COMPANY NAME (IF BEING USED FOR BILLING PURPOSES) VAT NUMBER BANK BRANCH BRANCH NUMBER ACCOUNT HOLDER ACCOUNT NUMBER ACCOUNT TYPE * SAVINGS CURRENT TERMS AND CONDITIONS * I agree to the terms and conditions of the service subject to the completion of the ordering process. If you are human, leave this field blank. Submit
