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012 880 4189
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Connect to the Future
Connectivity Sign-up Form
On-Site Contact Information
Name
Surname
ID Number
Email
Phone
Preferred contact method
Email
Phone
WhatsApp
Address Information
Type of residence
Free Standing House
Estate / Complex / Flat
Cottage (2nd residence on property)
Business
Address
Service Information
Check all that apply
Fibre
Wireless
LTE
Fibre to the Business
WiFi Required
Preferred link size
20Mbps
30Mbps
50Mbps
100Mbps
200Mbps
500Mbps
Preferred service contract term
12 Months
24 Months
Is a termination point already installed?
Yes
No
Not Sure
Additional Information
Submit
