Please complete the online form below, or you can download the application form:

Zoom Fibre Application Form PDF

 

    Sales Code

    Primary Contact Information

    Full Name *

    Phone *

    Email Address *

    ID/Passport Number *

    IDPassport

    Address *


    Billing Contact Information

    Full Name *

    Phone *

    Email Address *

    ID/Passport Number *

    IDPassport


    Company Information

    Company Details

    Company Address

    ID Document

    Proof of Residence

    Company Registration


    Fibre Information

    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


    Zoom Fibre Home Packages

    Please select the option that suits you best.

    Vumatel Home

    Price

    Download

    Upload

    R289R489R679R829R969R1129

    15Mbps30Mbps50Mbps100Mbps200Mbps500Mbps

    15Mbps30Mbps50Mbps100Mbps200Mbps500Mbps


    PAYMENT TERMS - DEBIT ORDER ONLY

    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: *


    This debit order mandate will be mailed to you for your records, please sign and return to home@activefibre.co.za.



    Abbreviated Name as Registered with the Bank: B2ETECH