Internet Client Registration Form & Debit Order Authorization |
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| Fill in on line and print if posible and fax to us thank you | |
Personal Details |
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| Surname / Business | |
| Vat Registration No (Business) | |
| Full Names | |
| ID / Reg No | |
| Postal Address | |
| Code | |
| Tel No | |
| Fax No | |
| Cel No | |
Which Service Do You Want To Register To ? |
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| Dail Up | |
| ADSL 1GB | ADSL 4 GB |
| ADSL Uncapped512Kbps | ADSL Uncapped 1024 Kbps |
| IBURST | |
| Month 2 Month | |
| Kickstart | Playa |
| Giga | Pro |
| Xstreme | Addict |
| 24 Month Contract | |
| Kickstart | Playa |
| Giga | Pro |
| Xstreme | Addict |
| IBurst Modem of your choice | |
| Usb Modem | Desktop |
| 3G HSDPA | |
| Data Manager | My Meg 500 |
| My Gig one | My Gig three |
| My Gig five | My Gig ten |
| Mail Boxes | |
| Stand Alone Mail Box | Extra Mail Box |
| Domains | |
| Park @ Us | |
| .co.za Domain Registration | .co.za Hosting + 2 Mail Boxes |
| .com Domain Registration | .com Hosting +2 Mail Boxes |
| Domain Name : http://www. | |
Domain Registration Subject to availability |
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Payment Agreement |
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Payment Methode |
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| Debit Order | Cash(only if paid 3 months in advance only on mail boxes) |
| 24 Month Contract | |
| Account Name | |
| Bank | |
| Branch Name | |
| Branch Code | |
| Account Number | |
Account Type |
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| Cheque | Transmission |
| Savings | |
| I/We herby undertake to prepay OasisNET, via the mentioned payment method, the amount due for the specifed service(s) on or before the 4th day of the respective month.I/We undertake to notify OasisNET, in writing, 30 Days before I/We want any service(s) and payment(s) stopped. If applicable I/we authorise OasisNET to debit my/our above mentioned bank account with the amount due for these service(s) on or before the 4th day of each month on a monthly/quarterly/half-yearly/yearly basis and I/We authorise these transaction(s) as if I/We signed the transaction(s) personally. I/We understand that if OasisNET does not receive these payment(s) within time, that I/we run the risk of losing any or all privilge(s)/service(s)/support I/we might have had, immediatley. If my/our use/misuse of any privilege(s)/service(s) provided by OasisNET was ever to be found unlawful by the applicable authorities, I/we hereby indemnify OasisNET completly from any prosecution and I/we take full full and personal responsibility for my/our action(s) which resulted in prosecution. I/we herby indemnify OasisNET completley from any loss of functionality or data incurred using any service of OasisNET. | |
| I Hereby Agree to all the TERMS & CONDITIONS above. | |
| Signature | |
| Assisted By(IF Required BY LAW) | |
| Date | |
| Prefered E-Mail (xxxx@oasisnet.co.za) | |
| Sign & Fax TO : 086 647 0910 | |
