Application Form – FAULT REPORT

Online Application Form ( Once Off Installation Fee worth R1500)

Title

Name and Surname *

Phone Number *

Email Address

ID Number/Passport Number *

Installation Address *

Products(Contention Ratio do apply on all internet packages) *

Billing Agreement *

Payment Method *

Banking Details

Debit order/Payment date *

By typing in your name in the box below, you Electronically sign and agree to the Electronic order, Credit Order, Direct deposit Mandate *

By typing your full name and surname in this box, you are officially signing the Electronic Mandate above, as well as our Terms of Service. The act of signing states that you agree to the Electronic Mandate and our Terms of Service in full and for every suspension due to non payment you will be liable for reconnection fee of R250. By clicking the ‘Submit’ button, you confirm that you have read and agree to the Fontel Terms of Service. For Voice application you must send your ID Copy and proof of residence for RICA purpose