FIBRE TO THE SUBURB FORM Fibre to the Suburb 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 FIBRE TO THE HOME PACKAGE OPTIONS Please select a package option from our 12 month or 24 month contract options. FTTS - 12 month contracts 10 MBPS DOWNLOAD/ 5 MBPS UPLOAD 12 Months - R 699 20 MBPS DOWNLOAD/ 10 MBPS UPLOAD 12 Months - R 899 30 MBPS DOWNLOAD/ 20 MBPS UPLOAD 12 Months - R 1199 75 MBPS DOWNLOAD/ 50 MBPS UPLOAD 12 Months - R 1499 100 Mbps 12 Months - R 1799 FTTS - 24 month contracts 10 MBPS DOWNLOAD/ 5 MBPS UPLOAD 24 Months - R 649 20 MBPS DOWNLOAD/ 10 MBPS UPLOAD 24 Months - R 799 30 MBPS DOWNLOAD/ 20 MBPS UPLOAD 24 Months - R 1099 75 MBPS DOWNLOAD/ 50 MBPS UPLOAD 24 Months 24 Months - R 1399 100 Mbps 24 Months - R 1699 PLEASE NOTE: Setup includes one point of connectivity. Any additional points in the home to increase connectivity will be an additional cost and quoted accordingly. FIBRE SETUP R1999 ONCE-OFF R750 x 3 MONTH PAYMENT REACTIVATION Please note: Reactivation only occurs once Fibre has been previously installed at your current location. Please select an option below that applies. REACTIVATION OPTION 1 - R499: REACTIVATION OF EXISTING FIBRE TO NEW CLIENT. FIBRE ROUTER STILL AVAILABLE OPTION 2 - R999: EXISTING FIBRE, NO ROUTER AVAILABLE. CUSTOMER NEEDS TO PURCHASE A FIBRE ROUTER. R199 Once-off Setup on all Packages VOIP PACKAGES V1 Package | 50 mins PREPAID - R85pm V2 Package | 100 mins PREPAID - R120pm V3 Package | 200 mins PREPAID - R190pm V4 Package | POST-PAID VOIP PHONE TO BE QUOTED DESKTOP HANDSET PORTABLE HANDSET 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
