Customer InformationEmail Address *First Name *Last NameSA Identification Number *Contact Number *Alternative Contact NumberStreet Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCompany Information (Business Customers Only)Company NameBilling ContactCompany Registration NumberCompany VAT NumberWireless Internet PackagesPackages - monthly contract *PackagesCapped Wireless - 20 gigs - R250Capped Wireless 50 gigs - R350Capped Wireless 100 gigs - R450Capped Wireless 200 gigs - R550Capped Wireless 300 gigs - R650Uncapped Basic Wireless 2Mbps - R450Uncapped Basic Wireless 2 - 4 Mbps - R500Uncapped Basic Wireless 3 - 6 Mbps - R600Uncapped Basic Wireless 4 - 8 Mbps - R700Uncapped Basic Wireless 5 - 12 Mbps - R800Uncapped Premium Wireless 4 Mbps - R600Uncapped Premium Wireless 6 Mbps - R800Uncapped Premium Wireless 10 Mbps - R1000Uncapped Premium Wireless 15 Mbps - R1200Uncapped Premium Wireless 20 Mbps - R1500Wireless Fiber 10 Mbps - R650Wireless Fiber 20 Mbps - R1200Special instructionsInstallation installation once-off payment *In Town R3000 *Rural Connection R3500installation once-off payment *In Town R3000*Rural Connection R3500Installation type *TAKE-OVER (no installation required)STANDARD WIRELESS INSTALLATIONinstallation special instructionsFree email addressEmail Address 1Email Address 2Terms and Conditions *I have read and agree to the Vryheid Wireless PTY LTD - Code of conductI have read and agree to theAcceptable Use PolicyI have read and agree to theComplaints Handling ProcedureBy marking your selections below you acknowledge that you read and understood the Code of Conduct and the Acceptable Use Policy and Complaints procedure Send Message Click Here to Complete your Debit order form Back to Home Page
