TEK Group Voice Services Signup & Quotation

1

Subscription Option* This field is required.

Month-to-Month Subscription — Client purchases the handsets outright; agreement continues month to month.

24-Month Agreement — R299 surcharge per extension per month for hardware and installation; client keeps the hardware after 24 months.

2

Company/Trading Name* This field is required.

3

Company Registration Number

4

Primary Contact Person* This field is required.

First Name

Last Name

5

Email* This field is required.

example@example.com

6

Mobile Number* This field is required.

Please enter a valid phone number.

7

Number of Extensions* This field is required.

8

App Option* This field is required.

Mobile App Included — R0 per month + R0 setup

Mobile App — R49 per extension/month + R250 setup

Desktop Enterprise App — R69 per extension/month + R300 setup

Desktop + Mobile Bundle — R99 per extension/month + R499 setup

9

Add Call Recording?* This field is required.R100 per extension per month

YESNO

10

Number Request* This field is required.

Get New Number

Port Existing Numbers

11

Number of Numbers to Port

12

Latest Telephone BillLatest Telephone Bill

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Max. file size: 10.0MB

13

Port Subscriber Name* This field is required.

14

Authorised Person Name and Designation* This field is required.

15

Porting Contact Number* This field is required.

Please enter a valid phone number.

16

South African ID / Passport Number* This field is required.

17

Porting Business Registration Number

18

Porting VAT Number

19

Present Service Provider* This field is required.

20

Present Service Provider Account Number* This field is required.

21

Porting Service Address* This field is required.

22

Fax-to-Email / Faxbox NumbersState any numbers being ported that are used for Fax-to-Email or Faxbox

23

Numbers Requested to be Ported and PABX Location* This field is required.List each telephone number and its PABX location

24

PRI / BRI Porting?* This field is required.

Yes

No

25

ADSL Line Porting?* This field is required.

Yes

No

26

Please ensure that none of the numbers requested for porting are linked to video conferencing services or are the target number for any 0800 or 086 service. I authorise TEK Group to request that my present service provider port the numbers stated above to TEK Group. I am duly authorised to make this request and confirm that the information is correct. I acknowledge that the subscriber remains liable under any existing provider contract while it remains in force; credits and discounts are not transferable; and the subscriber accepts the advised porting costs. PRI / BRI: numbers not ported may be lost and cannot be reinstated, and the customer must instruct the current provider whether to keep or cancel the infrastructure after porting. ADSL: the customer must state whether to assign a replacement number to retain DSL or accept loss of DSL functionality. Port cancellations are billed at R30.00 excluding VAT per number.

27

Port Authorised Name and Surname* This field is required.

First Name

Last Name

28

Port Request Date* This field is required.

Date

29

Port Request Authorisation Signature* This field is required.

30

Internet Choice* This field is required.

Use Own Internet

Internet Package Required

31

Connectivity Note

32

Payment Method* This field is required.

Debit Order

Card

EFT

Manual Payment

33

Account Holder

34

Bank

35

Company Registration / CIPC* This field is required.

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Max. file size: 10.6MB

36

Director ID* This field is required.

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Max. file size: 10.0MB

37

Proof of Address* This field is required.

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Max. file size: 10.0MB

38

Bank Confirmation Letter* This field is required.

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Max. file size: 10.0MB

39

Mandate Account Holder* This field is required.

40

Identity Type* This field is required.

RSA ID

Passport

Temporary ID

Business Registration Number

41

Identity Number* This field is required.

42

Mandate Cellphone Number* This field is required.

Please enter a valid phone number.

43

Mandate Email Address* This field is required.

example@example.com

44

Mandate Address* This field is required.

45

Mandate Bank Name* This field is required.

46

Branch* This field is required.

47

Branch Code* This field is required.

48

Mandate Account Number* This field is required.

49

Mandate Account Type* This field is required.

Current

Savings

Transmission

50

Contract Reference Number* This field is required.

51

Preferred First Collection Date* This field is required.

Date

52

Recurring Amount* This field is required.

53

Date Signed* This field is required.

Date

54

Authority and Mandate Terms Beneficiary: TEK Empire (PTY) LTD t/a TEK Group Address: 140 West Street, Sandown, Sandton Frequency: Monthly Date Adjustment: Yes Adjustment Rate: 100% A. AUTHORITY I/We hereby authorise TEK Empire (PTY) LTD t/a TEK Group to issue and deliver payment instructions to the Beneficiary bank for collection against my/our account at my/our bank on condition that the sum of such payment instructions will never differ from my/our obligations as agreed to in the Agreement. The individual payment instructions so authorised to be issued must be issued and delivered as stated above in Frequency and 1st Collection Date (as applicable) on the date when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement. The payment instructions so authorised to be issued must include an agreement number. This number must be included in the said payment instruction. This number must enable you to identify the Agreement. I/we agree that the first payment instruction and recurring payment instructions will be issued and delivered by the above-mentioned dates, and thereafter regularly ACCORDING TO THE AGREEMENT. If, however, the date of the payment instruction falls on a non-processing day (weekend or public holiday), I agree that the payment instruction may be debited against my account on the following business day. The use of the tracking facility may be used as provided in the EDO system at no additional costs and the tracking of dates to match with the flow of Credit should any of the debits return as unpaid. Subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid. This authority may be cancelled by me/us by giving you 30 calendar days written notice. B. MANDATE I/we acknowledge that all payment instructions issued by you shall be treated by my/our abovementioned bank as if the instructions had been issued by me/us personally. I/we agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you. C. CANCELLATION I/We agree that although this authority and mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/we also understand that I/we cannot reclaim amounts which have been withdrawn from my/our account (paid) in terms of this authority and mandate if such amounts were legally owed to you. D. ASSIGNMENT I/We acknowledge that this authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party.

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Debit Order Mandate Signature* This field is required.

56

Monthly Total

57

Once-off Total

58

First Payment Total

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Confirmation* This field is required.

I confirm that the information provided is accurate

I confirm that I have reviewed the quotation and selected services

I agree to proceed with the order

60

Identity Verification Selfie* This field is required.

61

62

Voice + Internet Package Monthly Fee

63

App Monthly Fee

64

Recording Monthly Fee

65

Hardware Surcharge per Extension

66

E-Signature* This field is required.