Please complete the online form below, or you can download the Application and Landlord Agreement form:

OpenServe Fibre Connect Premium Application Form OpenServe Fibre Connect Premium Landowner Permission Form

    PROMO Code

    Primary Contact Information

    Full Name *
    Phone *
    Email Address *
    ID/Passport Number *
    IDPassport
    Address *
    GPS Coordinates *

    Billing Contact Information

    Full Name *
    Phone *
    Email Address *
    ID/Passport Number *
    IDPassport

    Company Information

    Company Details
    Company Address

    Authorised Account Representative

    Full Name *
    Phone *
    Email Address *
    ID/Passport Number *
    IDPassport
    Customer Signature
    ID Document
    Proof of Residence
    Company Registration
    Utility Bill
    VAT Doc (if applicable)
    Landlord Agreement form

    BANDWITH OPTIONS

    Please select the option that suits you best.
    Package Speed Price
    50Mbps - Symmetrical100Mbps – Symmetrical200Mbps – Symmetrical300Mbps/150Mbps Asymmetrical500Mbps/250Mbps Asymmetrical R2000pmR2500pmR3000pmR3350pmR3800pm
    Terms
    12 Month Contract – R2000 excl vat Installation Payable on order
    24 Month Contract - FREE Installation

    PAYMENT TERMS - DEBIT ORDER

    For Debit Order please complete the debit order mandate below.

    Authority and Mandate for payments Instruction: Electronic and Written Mandates

    Given By (Account Holder):
    Address:
    Bank Name:
    Branch & Code:
    Account Number:
    Amount:
    Account Type:

    Debit Order will be processed on 1st Working Day of every month.

    Abbreviated Name as Registered with the Bank: ACTIVE FIB

    This signed Authority and Mandate refers to our contract (“the Agreement”)dated:

    • Kindly ensure that sufficient funds are available to avoid any payment issues. Please note, in the event of a debit order rejection, an administration/reactivation fee of R79.99 (incl. VAT) will apply.
    • Services will only be reactivated once full payment has been received.
    • Additionally, as services are bandwidth-provisioned, monthly charges will still apply during any suspension period, and payments will remain due.
    • Please note that no credits will be issued for any service downtime during suspension.
    I have read and accept the Active Fibre Debit Order Mandate Terms & Conditions.
    Signature of the duly authorised account holder and operator:

    This debit order mandate with all terms and conditions will be mailed to you for your records.


    Signature