Field Sales Form 2.0 Field Sales Form 2.0 Agents to select your company and name here.(Required) ๏ปฟCompany NameEvotelMoropi HoldingsInternet PlugItus ConsultantsAnto FibreShaazWEB CXLele TradingImpisi FibreGameconIT LinkPeet ChampionPree's I.T SolutionsEvotel RegionalSliq MarketingWerner PrinslooRJAY TradingLeenzo Group Agent Name 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 (Street 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) ๏ปฟInternet Service ProviderAcceleritAfrihostAxxessBioniqCool IdeasCiti TechClear AccessCrazywebCW WispC-wayDavo Business IntelegenceE-WispFASTRFibre FirstFibre FlyFliberGigs BroadbandGoldfieldsHome-ConnectInfinity WirelessImagineLevel 7Link-UpMwebNet4Octopi Smart SolutionsOpen LinkPacket SkyPresConnectRSAWEBSupersonicVoxVodacomWeb SquadWebAfricaWirulink Download / Upload Speed (Mbps) 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.Type of Installation(Required) First Line Second Line Multiple Lines Type of home Free Standing House Complex / MDU Back-room / Cottage Flat / Hostle MDU Address information (Estate / Complex Adress) Complex Name Complex Street Unit Number Write additional notes here.Referral CodeEnter your referral code above to earn discounts, enter competitions, win prizes or support your favorite local influencers and patrons.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.