Wireless Broadband Contract SME Izwi Connectix
Wireless Broadband Contract SME Izwi Connectix
Wireless Broadband Contract SME Izwi Connectix
Tel: 010 500 1414 Fax: 0865 242 224 E-Mail: [email protected]
REGISTRATION DETAILS
Contact Name
Company Name
Telephone
Company Trading
Fax
Cellular
Physical Address
Postal Address
ID Number
E-Mail Address
Once-Off
*VoIP Number
*VoIP Number Business (One Number + 4 Channels)
(Purchase VoIP Handset)
Google Hosted Mailbox (Month to Month User) 25GB Mailbox + 5GB Storage
Google Hosted Mailbox (Annual User) 25GB Mailbox + 5GB Storage
Domain/DNS/MX Records Hosting (Including 5 E-mail addresses)
Annual Domain Renewal Fee: .co.za
Annual Domain Renewal Fee: .com
PST/Mail Data Migration Assistants @ R350 p/h
Pro
Pro
Pro
Pro
Pro
Pro
Pro
Pro
Pro
Rata
Rata
Rata
Rata
Rata
Rata
Rata
Rata
Rata
Directors:
Johan Barkenhuizen
Web: www.izwi.co.za
R85
R75
R29
R100
R200
R
R
R1 200
R1 400
R1 700
R
R
R
_______________________________________________________________________________
Izwi Bridge Communications (Pty) Ltd
Tel: +27 87 550 1555
Fax: +27 865 242 224
R49
R100
Pro Rata
Pro Rata
Pro Rata
Equipment
Wireless CPE Installation (< 25km R750, < 75km R950)
Broadband Equipment (< 10km)
Broadband Equipment (< 20km)
Broadband Equipment (> 20km)
Additional Installation Equipment
Additional Configuration @ R250 p/Hour
Total
Additional Data @ R65/GB *Separate Application #IS
Monthly
R120
R390
R490
R690
R1090
R250
R1995
R
R
R
R
R
R
R
_____________
Signature
E-mail: [email protected]
Francois Swart
042011
_____________________
Date :
______________________
Address :
_____________________
Contract No. :
______________________
_____________________
Debit Amount :
______________________
_____________________
Commencement Date :
______________________
Contact No :
_____________________
Dear Sirs/Madams
The details of my/our account are as follows:
BANK :
________________________
BRANCH TOWN :
________________________
BRANCH NO. :
________________________
ACCOUNT NAME. :
________________________
ACCOUNT NO. :
________________________
TYPE OF A/C :
________________________
(savings, current,
transmission)
(mastercard, visa)
This signed Authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). I / We
hereby authorize you to issue and deliver payment instructions to the bank for collection against my / our
abovementioned account at my / our above mentioned bank (or any other bank or branch to which I / We may
transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our
obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this
Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 20 ordinary working
days, and sent by prepaid registered post or delivered to your address indicated above.
The individual payment instructions so authorized to be issued must be issued and delivered as follows:
i. On the First day (payment day) of each and every month commencing on _____________________.
In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the
payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the
nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for
payment as soon as sufficient funds are available in my account;
I / We understand that the withdrawals hereby authorized will be processed through a computerized system
provided by the South African Banks and I also understand that details of each withdrawal will be printed on my
bank statement. Each transaction will contain a number, which must be included in the said payment instruction and
if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the
issuing of any payment instruction. I / We shall not be entitled to any refund of amounts which you have withdrawn
while this authority was in force, if such amounts were legally owing to you.
_______________________________________________________________________________
Izwi Bridge Communications (Pty) Ltd
Tel: +27 87 550 1555
Fax: +27 865 242 224
Directors:
Johan Barkenhuizen
Web: www.izwi.co.za
_____________
Signature
E-mail: [email protected]
Francois Swart
042011
MANDATE
I / We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned bank as
if the instructions had been issued by me/us personally.
CANCELLATION
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 while this authority
was in force, if such amounts were legally owing to you.
ASSIGNMENT
I / We acknowledge that this Authority and Mandate has been ceded to Netcash (Pty) Ltd as per your agreement
with Netcash (Pty) Ltd, but in the absence of such assignment of the Agreement, this Authority and Mandate will be
null and void.
Signed at _________________ on this _________________ day of _________________ 20___
SIGNATURE AS USED FOR SIGNING CHEQUES OR CREDIT CARD VOUCHERS
Assisted by:
FOR OFFICE USE
AGREEMENT REFERENCE NUMBER
This Agreement reference number is: _____________________________________________________________
Documentation Required
Proof of Income:
(Payslip or Financial statements for business customers)
Proof of Bank Details: (Bank Statement (first page) or copy of valid credit card)
Proof of Residence: (Water & Electricity account)
Credit Vetting:
Copy of ID:
(Directors ID in case of business)
Domain Name
Email 1
Email 2
Email 3
Email 4
www.
_______________________________________________________________________________
Izwi Bridge Communications (Pty) Ltd
Tel: +27 87 550 1555
Fax: +27 865 242 224
Directors:
Johan Barkenhuizen
Web: www.izwi.co.za
_____________
Signature
E-mail: [email protected]
Francois Swart
042011
_______________________________________________________________________________
Izwi Bridge Communications (Pty) Ltd
Tel: +27 87 550 1555
Fax: +27 865 242 224
Directors:
Johan Barkenhuizen
Web: www.izwi.co.za
_____________
Signature
E-mail: [email protected]
Francois Swart
042011
_______________________________________________________________________________
Izwi Bridge Communications (Pty) Ltd
Tel: +27 87 550 1555
Fax: +27 865 242 224
Directors:
Johan Barkenhuizen
Web: www.izwi.co.za
_____________
Signature
E-mail: [email protected]
Francois Swart
042011
The Director
Izwi Bridge Communications (Pty) Ltd
PO Box 1800
Thabazimbi
0380
Dear Sir/Madam
Equipment Usage Izwi Bridge Communications (Pty) Ltd and _________________________________________
Please note that in terms of the abovementioned usage agreement, we are the legal owners of the following equipment:
Device: __________________________________________MAC: ___________________________
Cable: ____________________________________ Pole: __________________________________
Other: ____________________________________________________________________________
This equipment is currently in your possession at address ___________________________________.
This letter serves to confirm that the abovementioned equipment shall at no stage during the currency of a financial agreement
be subject to your legal hypothec in the event of default your obligations of whatsoever nature.
Yours sincerely
________________________
_________________________
_____________________________
ISP______________________
Date: _______________
Date: _______________
Date: _______________
_______________________________________________________________________________
Izwi Bridge Communications (Pty) Ltd
Tel: +27 87 550 1555
Fax: +27 865 242 224
Directors:
Johan Barkenhuizen
Web: www.izwi.co.za
_____________
Signature
E-mail: [email protected]
Francois Swart
042011