Crazyweb Fibre Application Form. This field is hidden when viewing the formDate MM slash DD slash YYYY Choose a sales agent Company NameEvotelMoropi HoldingsInternet PlugItus ConsultantsAnto FibreShaazWEB CXLele TradingImpisi FibreGameconIT LinkPeet ChampionPree's I.T SolutionsEvotel RegionalSliq MarketingWerner PrinslooRJAY TradingLeenzo Group Agent Name If you have been assisted by an agent and have received good service you can attribute the agent here.Client DetailsYour Full Name(Required) First Last Your Phone Number(Required)Please enter your preferred phone number.Your Email Address(Required) Enter Email Confirm Email Please enter your preferred e-mail address. This field is hidden when viewing the formGeocoderLocator ButtonGet my current positionMapAddress Select a package(Required)10 / 2 Mbps – R489 pm* (On Special)30 / 30 Mbps – R649 pm* (On Special)75 / 75 Mbps – R749 pm* (On Special)125 / 125 Mbps – R1145 pm*300 / 300 Mbps – R1325 pm*850 / 850 Mbps – R1495 pm*Choose your preferred line speed and price here.Banking DetailsSouth African ID Number(Required)Please enter your 13 digit South African ID NumberSelect Your Bank(Required)Standard BankFirstRand BankAbsaNedbankInvestecCapitecGrindrod BankMercantile BankBidvest BankSasfinAlbaraka BankUbankHBZ BankSouth African Bank of AthensTyme DigitalHabib Overseas BankDiscovery BankAccount Name(Required)Branch Code(Required)Bank Account Number(Required)Contract Terms This signed Authority and Mandate refers to our contract as dated as on signature hereof (“the Agreement”). I / We hereby authorise you to issue and deliver payment instructions to the bank for collection against my / our above mentioned account at my / our above mentioned bank (or any other bank or branch to which I / We may transfer my / our account) 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 30 calendar days, and sent by letter or e-mail or delivered to your address indicated above. The individual payment instruction so authorised to be issued must be issues and delivered as follow: i. On the last working day of each and every month commencing on the abovementioned commencement date. ii. 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 previous working day. iii. 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 authorised 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. 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 may be ceded to or assigned to a third party if the agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party. Please attach the following proofProof of SA Identity documentAccepted file types: jpg, jpeg, png, pdf, gif, heif, hevc, Max. file size: 15 MB.Please attach a picture or screenshot of your South African ID documentProof of Bank account / Bank confirmation letter(Required)Accepted file types: jpg, jpeg, png, pdf, gif, heif, hevc, Max. file size: 15 MB.Please add a bank confirmation letter, this can be found in the documents section of your banking app or from an ATM / 3 months bank statements will also suffice.Proof of credit scoreAccepted file types: jpg, jpeg, png, pdf, gif, heif, hevc, Max. file size: 15 MB.Please attach a screenshot or image of your credit score to help speed up your application process, if proof of credit score is attached we will need to request this from Transunion which may delay the approval process.Consent(Required) I have read, understood and agree to the below terms & conditions.Terms & Conditions All promotions including not limited to special promo offers 10/2, 30/30 and 75/75 will only be available and effective for duration from 26 November 2024 to and end 31 December 2024. The duration terms are explicitly stated on The Promoter shall have the right to change or terminate the promotional competition immediately and without notice, if deemed necessary in its sole discretion, including but not limited to: Any change of the offer. Any termination of the offer. Any offer expiry date changes. Any alterations to the offer. By completing this consent checkbox participants agree to the following: Allow Crazyweb Pty (LTD), and its partners to utilise / share the personal information contained in the above form to facilitate the service and or the installation of the service contained in the offer. The Purchaser agrees to waive any rights that they have in respect of this promotion / competition and acknowledge that they will have no recourse against the Promoter or its agents, for any alterations to the promotion / offer, and that winners selected are selected at the sole discretion of the promoter / seller.Please Sign Here(Required)By signing you confirm, that you have read and understand the above contract, and terms and conditionsEmailThis field is for validation purposes and should be left unchanged. Contact Us: Tel: 034 312 7005 Crazyweb Website Support: Support : 082 343 0560