Contract Application Form

Please complete the entire form. All fields are MUST be filled in as we cannot process an incomplete application.
You will be contacted via phone or e-mail as soon as your application is approved or declined.

You will be required to come in to sign your Contract and collect your Products.
Once we have your Contract approved the following supporting documentation will be required:

A. If the Contract in your personal name:

  1. Copy of your ID
  2. 3 Months Bank Statement (Original from Bank, Internet printout is not accepted)
  3. Utility Bill for FICA
  4. Your Latest Payslip
B: If the Contract is in your Company Name:
  1. Copy of your ID
  2. Your Utility Bill for FICA
  3. Copy of Company Registration Documents.
  4. 3 Months Company Bank Statement (Original from Bank, Internet printout is not accepted)
  5. Letter on your Company's letter headed stating that you are allowed to apply for this contact.

Please Select Contract Required Below

Please Select Contract Required ( Deals Valid till 6 June 2014 and while stocks last)





If Required Contract is NOT Listed above specify requirements here:
Did a Salesperson help you, Select Name or NONE:



Would you like to keep your existing PREPAID cellular number ? If yes please provide cell number and sim card number and which network provider
Would you like to keep your existing contract cellular number ? If yes please provide cell number and account number and which network provider
Do you want to apply in your personal or company name ?

Your Surname:
Your First Names (Specify all names):
Your ID Number:
Home Physical Address:
Gross Monthly Salary:
Montly Expenses:
E-Mail Address:
Home Phone Number:
Employer's (Work) Phone number:
Your Cell Phone Number:
Postal Address:
Marital Status:
Name of Employer (Company Name):
Years at Current Employer:
Work Address:
Salary Date (When you get Paid):
Full Name of a Friend or Relative:
Contact Number for the Friend or Relatives Named Above:
Debit Order Date:
Type of Bank Account (Cheque/Savings):
Your Bank Account Number:
Name of your Bank eg: FNB, STD, ABSA:
Bank Branch Code: