Evotel Affiliates – Sales Agent Form Affilliate Name:(Required) First Last Affiliate Code:(Required)Clients Name(Required) First Last Enter your clients full name here.This field is hidden when viewing the formGeocoderUse this button when you are at your clients installation addressLocate this addressClients Installation address(Required) Confirm your clients address where the clients fibre should be installed.Ensure marker is on your clients Rooftop (installation address)If the marker is not on the clients rooftop please move the marker by clicking / tapping the map on the clients home.This field is hidden when viewing the formGPS co-ordinates(Required)Insert your GPS co-ordinates from the mapPackage and Pricing(Required) Fibre Line Speed (Download / Upload)10/2Mbps30/30Mbps75/75Mbps125/125Mbps300/300Mbps850/850Mbps Installation: Free / Once Off Internet Service Provider & Package Select your preferred speed, installation type and ISP.Clients Cell Phone Number(Required)Enter your primary contact number here.Clients Alternative Phone numberClients Email Address(Required) Enter Email Confirm Email Please Enter your clients e-mail address here.Write additional notes here.Keep me informed of Marketing offers, notifications & product updates. I grant permission to receive updates and notifications Grant Consent(Required) I agree to allow my information to be shared with Evotel and its affiliated companies in order to get my internet installed.NameThis field is for validation purposes and should be left unchanged.