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):
    Contact Number:
    Address:
    Bank Name:
    Branch & Code:
    Account Number:
    Amount:
    Account Type: *
    This debit order should be processed on:
    of every month

    Abbreviated Name as Registered with the Bank: ACTIVE FIB

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

    I / We hereby authorise you to issue and deliver payment instructions to your Banker for collection against my / our abovementioned account at my / our above-mentioned Bank (or any other bank or branch to which I / we may transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our obligations as agreed to in the Agreement and commencing on and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of not less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address as indicated above.

    The individual payment instructions so authorised to be issued must be issued and delivered as follows: monthly. In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the preceding ordinary business day.

    I / We understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction.

    Mandate

    I / We acknowledge that all payment instructions issued by you shall be treated by my / our above-mentioned Bank as if the instructions have been issued by me/us personally.

    Cancellation

    I / We agree that although this Authority and Mandate may be cancelled by me / us, such cancellation will not cancel the Agreement. I / We shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such amounts were legally owing to you.

    Assignment

    I / We acknowledge that this Authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

    Signature as used for operating on the account:

    Upon activation of service, a pro-rata amount will be invoiced and debited within 1 to 2 days. 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.


    Signature