MetroFibre Application

PROMO Code

Full Name *

Phone *

Email Address *

ID/Passport Number *

IDPassport

Address *

Select ProvinceGautengEastern CapeFree StateKwaZulu-NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape

Full Name *

Phone *

Email Address *

ID/Passport Number *

IDPassport

Company Details

Company Address

Select ProvinceGautengEastern CapeFree StateKwaZulu-NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape

ID Document

Proof of Residence

Company Registration

Is Fibre Installation Required?

YesNo

Please confirm package type below

Pay for Installation Upfront with a free Activation and Free Router with 6 month claw backIf Already Installed, Free Activation and Free Router with a 6 month claw back

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: *

Contact Number: *

Date: *

Payment Instructions due in December may be debited against my account on: *