RICHMOND FTTH FORM FTTH - Richmond By filling in the below form, you are confirming consent to your personal data being processed for the Solid Fibre order form purpose as described below. Please make sure all required fields are filled in. Required fields are marked with an asterix. (*) NAME * NAME First First Last Last EMAIL (TO BE USED FOR BILLING PURPOSES) * PHONE * ADDRESS FOR FIBRE TO BE ACTIVATED * ADDRESS FOR FIBRE TO BE ACTIVATED ADDRESS FOR FIBRE TO BE ACTIVATED ADDRESS FOR FIBRE TO BE ACTIVATED City City State/Province State/Province Zip/Postal Zip/Postal FIBRE TO THE HOME PACKAGE OPTIONS Please select a package option from our 12 month or 24 month contract options. FTTH - 12 month contracts 15 Mbps - R699/month 12 MONTH 30 Mbps - R899/month 12 MONTH 75 Mbps - R1199/month 12 MONTH 100 Mbps - R1499/month 12 MONTH FTTH - 24 month contracts 15 Mbps - R649/month 24 MONTH 30 Mbps - R849/month 24 MONTH 75 Mbps - R1149/month 24 MONTH 100 Mbps - R1449/month 24 MONTH PLEASE NOTE: Setup includes one point of connectivity. Any additional points in the home to increase connectivity will be an additional cost and quoted accordingly. FIBRE SETUP R999 ONCE-OFF MESSAGE We as a company, would advise our customers to sign up with our Debit order facility. The Debit order simplifies the billing process. If you select the EFT option. Please note we will charge an additional R50.00 per month for Administration purposes. If payment has not been received by the 1st of the billing month, your account will be suspended and once payment has been received, we will charge you a reconnection fee of R80.00. In a case where your debit order bounces the, reconnection fee will apply. PAYMENT OPTIONS * DEBIT ORDER FACILITY EFT (ELECTRONIC FUNDS TRANSFER) BILLING ADDRESS * BILLING ADDRESS BILLING ADDRESS BILLING ADDRESS City City State/Province State/Province Zip/Postal Zip/Postal COMPANY NAME (IF BEING USED FOR BILLING PURPOSES) VAT NUMBER BANK BRANCH BRANCH NUMBER ACCOUNT HOLDER ACCOUNT NUMBER ACCOUNT TYPE SAVINGS CURRENT TERMS AND CONDITIONS * I confirm that I have read and agree to the Terms and Conditions of service, and acknowledge that Solid Fibre will provide my internet service over fibre infrastructure owned and operated by Light Fibre Infrastructure. Submit If you are human, leave this field blank.
