Vumatel Application

PROMO Code

—Please choose an option—AFJHB01AFKZN01

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

If installed, please confirm object number / FSAN number / Unknown

(If unsure don’t worry we will assist in finding this out for you)

Please confirm package type below

NEW INSTALLATIONS ONLY i.e Not previously installed homes – Free Installation, Free Activation and Free to Use Router with a minimum commitment of 6 Months.If already installed – Free Activation and Free to Use Router with a minimum commitment of 6 Months.Faulty previously installed ONT (infrastructure damage or fibre cable broken) or Requested ONT to be moved will incur a charge of R1725 and will be payable on order. Activation Free and Free to use router with a minimum commitment of 6 months.

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: *