DIALUP PACKAGE

Fill in the form below for IMMEDIATE access to your 56K Dialup Circuit (R 59.00 per month)
Including your FREE 2048 MB Mailbox.

2. BILLING INFORMATION

NAME / COMPANY NAME:

ID OR COMPANY REGISTRATION NO:

MOBILE NUMBER

TELEPHONE NUMBER:

VAT NUMBER (if applicable):

CHOOSE YOUR EMAIL:

@cybersmart.co.za

WHERE WOULD YOU LIKE YOUR INVOICES SENT TO?

MY NEW CYBERSMART EMAIL ADDRESS

MY CURRENT EMAIL ADDRESS

STREET ADDRESS:

POSTAL ADDRESS:

BANK NAME:

ACCOUNT TYPE:

ACCOUNT NUMBER:

Account number must contain digits only

BRANCH CODE:

I HAVE read, understood and accept the terms and conditions