Evotel Affiliates – Sales Agent Form

Affilliate Name:(Required)
Clients Name(Required)
Enter your clients full name here.
Confirm your clients address where the clients fibre should be installed.
If the marker is not on the clients rooftop please move the marker by clicking / tapping the map on the clients home.
Insert your GPS co-ordinates from the map
Select your preferred speed, installation type and ISP.
Enter your primary contact number here.
Clients Email Address(Required)
Please Enter your clients e-mail address here.
Keep me informed of Marketing offers, notifications & product updates.
This field is for validation purposes and should be left unchanged.