Termination Point & Fibre Package Order Form (Somerset Gardens)

Unit Number

First Name

Surname

ID/Passport Number

Mobile 1

Mobile 2

Email Address

Are you a Tenant/Owner? Are you a Tenant/Owner? Owner Tenant

Have you got a Termination Point (TP)? Have you got a Termination Point (TP)? Yes No

Would you like a Fibre Package? Would you like a Fibre Package? Yes No

Select a Router -- Select a Router --GigaHub (Single Band - Free Life Time Rental)GigaCentre (Dual Band - R150pm)

Select a Package -- Select a Package --Surf 10 (10 Mbps)Flix 25 (25Mbps)Gamer 50 (50Mbps)Family 100 (100Mbps)Ultra 200 (200Mbps)

When should you be activated? When should you be activated? As soon as possible I require to give my current ISP a notice period Date of my own choosing

How many days is your notice Period?

Date of Activation (dd/mm/yyyy)

I acknowledge my termination point is not free and I am liable for the cost of this. I acknowledge my termination point is not free and I am liable for the cost of this. Yes

I acknowledge the GigaHub modem/ONT with a package is free. I acknowledge the GigaHub modem/ONT with a package is free. Yes

I acknowledge there is a once-off connection fee of R999.00. I acknowledge there is a once-off connection fee of R999.00. Yes

I acknowledge that a pro-rated invoice is sent when the line is activated. I acknowledge that a pro-rated invoice is sent when the line is activated. Yes

I acknowledge that all monthly billing is due in advance. I acknowledge that all monthly billing is due in advance. Yes

I acknowledge that I have read the Terms and Conditions. I acknowledge that I have read the Terms and Conditions. Yes

I acknowledge that the line will be suspended with non-payment. I acknowledge that the line will be suspended with non-payment. Yes

I acknowledge that the owner of the unit has granted the tenant to get the termination point. I acknowledge that the owner of the unit has granted the tenant to get the termination point. Yes

I acknowledge that the tenant will be liable for the account. I acknowledge that the tenant will be liable for the account. Yes

Please supply the contact information of the owner here

I acknowledge that I have read the FAQ. I acknowledge that I have read the FAQ. Yes