User Registration

INDIVIDUAL SUBSCRIBER AGREEMENT

134 Walton Avenue, Carlswald, Midrand, South Africa. 018 500 0100 sales@wayawayafibre.co.za
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Sales Agent
Dealer NameAgent Name
Customer Details
Customer Name*

First NameLast Name
ID Number*
Please add a valid ID number
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Complex Name
Select your Package

Pricing includes vat
10/5 Mbps R 37920/5 Mbps R 39950/50 Mbps R 959100/100 Mbps R 1249200/200 Mbps R 1549
Debit Order Authorisation

Please input your debit order details below
I/We hereby request V&D Telecomms (Pty) Ltd. t/a Voice & Data to draw against my/our account the total amounts required under this agreement or any renewal thereof and I/we authorize my/our bank (or any other bank or branch to which my/our account has been transferred) to debit my/our account with any amounts drawn against it in terms of this agreement. In the event that the preferred debit date falls on a Sunday, or recognised South African public holiday, the debit instruction will automatically be for the next business day. Furthermore, if there are insufficient funds in my/our account to meet the obligation, V&D Telecomms (Pty) Ltd. t/a Voice & Data is entitled to represent the instruction for payment as soon as sufficient funds are available in my/our bank account.
Branch Name*
Bank Name*
Branch Code*
Account Holder*
Account Number*
1st10th15th25th28th
Copy of ID*

Cancelof
Proof of banking details*

Cancelof
Subscriber Declaration
I/We hereby warrant that the above information is true and correct for any services to be provided by V&D Telecomms (Pty) Ltd. t/a Voice & Data (Hereafter referred to as “Voice & Data”) and by my signature hereto, I irrevocably offer to enter into this Individual Subscriber Agreement with Voice & Data upon the terms set out in the Individual Subscriber Agreement Terms & Conditions as provided electronically below; which I have read, understood and agree to be bound by in all respects. I acknowledge that these Terms & Conditions may change in accordance with the law without notification. I also acknowledge that pending Voice & Data’s acceptance hereof, I shall have no claims against Voice & Data arising out of this application. Any additional callout and travelling costs, as made available to the me on request from Voice & Data, are subject to Voice & Data’s standard callout and travelling costs. I hereby give permission to Voice & Data to do any credit checks it may deem necessary.
Authorised Signature:
Should be Empty:

INDIVIDUAL SUBSCRIBER AGREEMENT

Sales Agent

Customer Details

Select your Package

Debit Order Authorisation

Subscriber Declaration