MetroFibre Application

PROMO Code

Full Name *

Phone *

Email Address *

ID/Passport Number *

Address *

Staying in Free Standing house or Cottage *

Full Name *

Phone *

Email Address *

ID/Passport Number *

Company Details

Company Address

ID Document

Proof of Residence

Company Registration

Is Fibre Installation Required?

Please confirm package type 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.

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