Reseller – Field Sales Sign Up

Field Sales Form 2.0

Agents to select your company and name here.(Required)

Clients Name(Required)

First Last

Enter your clients full name here.

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Geocoder

Use this button when you are at your clients installation address

Clients 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.

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GPS co-ordinates(Required)

Insert your GPS co-ordinates from the map

Package and Pricing(Required)

Select your preferred speed, installation type and ISP.

Clients Cell Phone Number(Required)

Enter your primary contact number here.

Clients Alternative Phone number

Clients 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 Code

Enter 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.

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Name

This field is for validation purposes and should be left unchanged.