Customer Information

Your Email

name & surname

SA Identification Number

Cell Number

Alternative Contact Number

Installation Address

Employment Information

Employer

Employer Contact Number

Next of Kin Information

Name and Surname(next of kin)

Next of Kin Contact Number

Company Information(Buisness Customers Only)

Company Name

Billing Contact

Company Registration Number

Company VAT Number

Wireless Internet Packages

Packages - monthly contract
---512Kbps-1Mbps 2 Gig(R150)512Kbps-1Mbps uncapped(R450)1-2Mbps 5Gig(R250)1-2mbps 10Gig(R350)1-2Mbps 20Gig(R500)1-2Mbps 30Gig(R600)2Mbps uncapped(R800)2-4Mbps 5Gig(R350)2-4Mbps 10Gig(R450)2-4Mbps 20Gig(R600)2-4Mbps 30Gig(R800)4Mbps uncapped(R1000)10Mbps 10Gig(R650)10Mbps 20Gig(R800)10Mbps 30Gig(R1000)10Mbps uncapped(R1500)

special instructions

Installation

installation once-off payment *In Town R1500
*Rural Connection R2000

installation type
TAKE-OVER(no installation required)STANDARD WIRELESS INSTALLATION

installation special instructions

Additional Hadware

wireless router(R600)Wifi router(R500)

Free email address

Debit Order Instructions

Debit Order Mandate:
I hereby authorise WikiWorx to draw against my account on the 1st day ("payment day") of each and every month commencing as stipulated in this contract. In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account;

I hereby agree to the debit order mandate

account name

bank name

branch name

branch code

account number

account type
---Cheque accountSavings account

Debit order ammount

Terms and Conditions

By marking your selections below you acknowledge that you read and understood the Code of Conduct and the Acceptable Use Policy and Complaints procedure

I have read and agree to the WikiWorx - Code of conduct

I have read and agree to theAcceptable Use Policy

I have read and agree to theComplaints Handling Procedure