New Client Registration

Bakwena Telecoms Subscriber Application Form
Subscriber Application Form
Client/Account Information
Name / Business Name:*
Surname:*
ID Number / Business Registration No:*
VAT No: (If Applicable)
Cellphone:*
Alternative Cellphone:*
Installation Address
Street Address:*
Street Address Line 2:
City:*
Province:*
Area Code:
E-mail address:
example@example.com
Billing Infomation

Same as above
Name / Business Name*
Surname*
Street address*
Street address line 2
Province:
City:
Area Code:
Payment Date*

1st of the Month16th of the Month27th of the Month
- Customer's Full Names & I.D Copy are Required
- Companies must be Registered with CIPC & in Business
Upload Cert ID /Company Registration:

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Installation & Equipment
*Installation Fees may differ due to availabilty & Standard Equipment Terms & Cost's

* Please see our full T&C's on our website
° Standard Once-off Equipment & Installation fee of R850 for Wonke Wonke packages (Equipment is Owned by Bakwena Telecoms for duration of use)

° Standard Once-off Equipment & Installation fee of R1500 for Air Fibre packages (Equipment is Owned by Bakwena Telecoms for duration of use)

° No Installation fee for Openserve Fibre Covered areas
Choose Your Package Below:
Client Consent*

I Client/Representative accept the above terms and conditions which can be viewed on the Bakwena Telecoms website
Signature

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Please verify that you are human*
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Subscriber Application Form