Wireless Internet Application form · TOTO-LINK N600R WIRELESS ROUTER TOTO-LINK N300RH WIRELESS...
Complete Contact Details ( ALL CAPS ) CUSTOMER TYPE: INDIVIDUAL COMPANY COMPANY REG NO: FIRST NAME: LAST NAME: TITLE: IDENTITY NUMBER: BIRTH DATE: DD / MM / YY MOBILE NUMBER: EMAIL ADDRESS: HOME NUMBER: WORK NUMBER: PHYSICAL ADDRESSS: POSTAL ADDRESSS: RECEIVE EMAILS / UPDATES ON SPECIALS: YES NO RECEIVE EMAILS / DATA USAGE : YES NO Select your Equipment Installation Type 24 MONTH CONTRACT 24 MONTH CONTRACT RENT ONLY: R100p/m RENT TO OWN: Rent: Antenna, Bracket, Pole, 1 x Network Point*Excluding Wi-Fi Router* Rent: Antenna, Bracket, Pole, 1 x Network Point*Excluding Wi-Fi Router* MONTH TO MONTH CONTRACT ONCE OFF: R2500 Once Off: Antenna, Bracket, Pole, 1 x Network Point*Including STD Wi-Fi Router* Select Wi-Fi Router Type TOTO-LINK N600R WIRELESS ROUTER TOTO-LINK N300RH WIRELESS ROUTER TOTO-LINK AC WIRELESS ROUTER 600Mbps Wireless N speed Stable Wireless Perfomance Boost your wi-fi by Turbo Switch 4 x 10/100Mbps Ethernet LAN Ports 600Mbps Wireless N speed Ultra-broad Wireless Coverage 11dBi High Gain antennas 4 x 10/100Mbps Ethernet LAN Ports 1.2Gbps Fast Wi-Fi MU-MIMO Technology / 802.11ac wave2 Simultaneous Dual Band 1Ghz CPU for Powerful Performance 4 x 10/100Mbps Ethernet LAN Ports R499.00 R750.00 R750.00 Wireless Internet Application form Address 22 Debussy street Dalvale Paarl 7646 Contact us Office: 021 001 8851 Accounts: 021 001 8820 Email [email protected][email protected][email protected]Reg.No: 2014/029533/07 R125p/m
Wireless Internet Application form · TOTO-LINK N600R WIRELESS ROUTER TOTO-LINK N300RH WIRELESS ROUTER TOTO-LINK AC WIRELESS ROUTER 600Mbps Wireless N speed Stable Wireless Perfomance
Bank Account number Abbreviated Shortname as registered with the acquiring bank:
Type of Account Refer to our Contract Reference Number:
I/We hereby request, instruct and authorize you to debit my/our above mentioned bank account at the above mentioned bank with R being the amount required for payment of the monthly installment due in respect of the above mentioned agreement on the chosen date below
Date to choose from
I/We hereby authorise to EM-IT Technologies (Pty) Ltd issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned bank on condition that the sum of such payment instructions will not differ from my/our obligations as agreed to in the Contract Reference Number.
I/we understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African banks. I also understand that details of each withdrawal will be printed on my bank statement. Such must contain a number, which must be included in the said payment instruction and if provided to me should enable me to identify 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; or subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the agreement have been paid or until this authority is cancelled by me/us by giving you notice in writing.
I/We agree to pay any bank charges relating to this debit order instruction. This authority may be cancelled by me/us
by giving you 30 day’s notice in writing, sent by prepaid registered post, but I/we understand that I/we am/are not entitled to a refund of amounts withdrawn by you while this authorisation was in force. Receipt of this instruction by you shall be deemed receipt thereof by my/our bank (as the case may be)
I/We acknowledge that my /our above-mentioned Bank shall treat all payment instructions issued by you as if the instructions have 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 whilst this authority was in force, if such amounts were legally owing to you.
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, but in the absence of such assignment of the agreement, this Authority and mandate cannot be assigned to any third party.