FIBRE TO THE SMALL BUSINESS FORM FTSB - Small 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. FTSB - 12 month contracts 10 Mbps 12 Months - R 1099 20 Mbps 12 Months - R 1599 50 Mbps 12 Months - R 2799 100 Mbps 12 Months - R 5499 FTSB - 24 month contracts 10 Mbps 24 Months - R 999 20 Mbps 24 Months - R 1499 50 Mbps 24 Months - R 2499 100 Mbps 24 Months - R 5199 PLEASE NOTE: Setup includes one point of connectivity. Any additional points to increase connectivity will be an additional cost and quoted accordingly. FIBRE SETUP R3500 ONCE-OFF VOIP ADD-ON R 1725 Once-off | NRC R 1380pm | MRC 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. Submit
