Openserve order form

Name

First NameLast Name

Company Name

Optional (For business)

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

ID Number*

Email*

example@example.com

Invoice made out to

Optional (For business)

Vat number

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Phone Number*

Please enter a valid phone number.

Payment Method*

Debit OrderEFT

Installation: (Free) Ruijie Router: (R780)

1) Router payable within 24 hours of installation.                                                                                                                                                                 &#13;&#10;2) Pro-rata services to be paid within 24 hours of receiving the invoice. (Bank details below)&#13;&#10;3) First 30m of cabling is free, a quote will be provided by the contractor for any excess cabling required&#13;&#10;4) All Monthly Subscriptions are due in advance and by the 1st of every month.

Please tick your chosen package below*

Signature*

CAPITEC ACCOUNT DETAILS:

Capitec Business Account
Account Name: Crimson Moon Trading CC
Account Number:1054539600

Branch Code: 450105

Openserve Order Form