Authorized Telkom Dealer

Application Form

Supporting Documentation

• Proof of identification: Copy of SA ID or passport (including work permit)

Example of ID (Please ensure that signature and date is clearly visible)

• Copy of proof of residence (utility bill not older than three months)
• Copy of proof of bank account

All Fields with * are mandatory

Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Please check this box & Whatsapp to: 064 767 4128

1. Customer Details

Contact Details

Physical Address

Postal Address

Delivery Address

2. Employment Details

3. Your Internet Plan

4. Payment Details

5. Agreement

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064 767 4128

www.fibremax.co.za

info@fibremax.co.za