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Service Application
This form is to have your correct details on our system that we can provide and assist you with the service you requested, this information will be used in setting up your service and for invoice purposes.
Please enter your email below and kindly fill in the required fields below.
* Indicates required question
Email
*
Record my email address with my response
First Name
*
Your answer
Last Name
*
Your answer
Address
*
Please note we require a valid address for Uncapped Fibre, Fixed LTE & LTE for the services to be setup & ordered accordingly
Your answer
Phone Number
*
Your answer
Company Name
Your answer
Communication Preference
*
Email
Whatsapp
Phone
Required
Service Requested
*
Please fill in Preferred Domain Name below if your request is WordPress, Website & Email Hosting related
Your answer
Preferred Domain Name
Your Preferred Domain Name might not be available, in cases where the domain name is not available, we will inform you of such.
Your answer
Send me a copy of my responses.
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