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043 722 4466
accounts@vsinternet.co.za
17 Lukin Rd, Selborne, East London
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Call Now 043 722 4466
MON – FRI 8AM – 16:30pm
Remote Support: MON – Sun 16:30 – 21:00pm
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1. Applicant Details
Name
*
First
Last
ID / Passport No
*
Date of Birth
*
Email
*
Contact Number
*
Digital Signature (Full Name)
*
2. Service Address
Street Address
*
Address Line 1
City
State / Province / Region
Postal Code
3. Package Selection
Select your option
*
Uncapped Wireless – R350/month/10MBPS (Specific areas: Parkside, Pefferville, Parkridge, Buffalo Flats, East Bank, Scenery Park, Highway Gardens, Southernwood)
Other:
Single Line Text
Digital Signature (Full Name)
*
4. Bank Debit Order Details
Account Holder Name
*
Bank Name
*
Branch Code
*
Account Number
*
Debit Order Date
1st
7th
15th
25th
Debit Order Authorisation:
*
I hereby authorise VSI Internet to debit my account monthly for the selected internet package until cancellation in writing.
Digital Signature (Enter Your Full Name) (Debit Order Authorisation):
*
5. Terms & Conditions
I understand Standard Terms
*
Services are subject to coverage availability in your area. Installation is typically 5-7 days upon receipt of the completed application form. Payment is due monthly in advance. Standard fair usage policies apply. Installation fees (if applicable) are non-refundable.
Read
Terms & Conditions.
Authorisation: Text Terms
I understand Promotion Terms & Conditions
*
Promotional prices apply only for the duration specified in the promotion. All equipment is on a Free-to-use policy and remains the property of VSI. R170 once-off Activation fee applies. – Monthly subscription for the first 12 months is R350/month, and R399/month for the second 12-month period. 10 device limit per connection. Cancellation fee prior to the 24-month expiry is 40% of the remainder of the contract. After the promotional period, standard package rates will apply. Promotions are non-transferable and cannot be exchanged for cash. VSI reserves the right to amend or withdraw promotions at any time.
Digital Signature (Enter Your Full Name) (I understand T&Cs):
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Call Now 043 722 4466
MON – FRI 8AM – 16:30pm
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