Internet Service Application Form

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Name

First

Last

Omang / Passport / ID

Business Name

Trading Name:

Company Registration Number:

VAT Number:

Postal Address:

Physical Address:

Physical Trading Method:

Area / Award / Extension:

City:

Office Phone Number (Work/Fax)

Mobile Number:

Alternative Contact (Name / Phone )

Package / Service

12 Months
24 Months

(Tick Applicable) Minimun Contract Term:

FTTB:

5 Mb
10 Mb
20 Mb
40 Mb

FTTH:

5 Mb
10 Mb
25 Mb
50 Mb

Wireless

5 Mb
10 Mb
20 Mb

Satellite Installation Available

Home
Business
Priority

Dedicated Speed @ .....4MBps

Media
Fibre
Radio

(Priced as Quoted) NOTE: ALL ABOVE PACKAGES ARE EXCLUSIVE OF LOCAL ROUTER, INSTALLATION, DATA-DROP INSTALLATIONS. ANY ADDITIONAL CHARGES SHALL BE COMMUNICATED PRIOR TO THE START OF THE SERVICE. ALL SPEEDS ARE SHOWN AT MAXIMUM THROUGHPUT AND REFLECT THE BEST-EFFORT SPEED AVAILABLE.

Invoices are only sent electronically to an email.

Please indicate the email address to receive your invoices:

Payment Method:

EFT
Debit-Card
Cash
On Account

[MUST attach a VOIDED/Cancelled blank or USED cheque for account verification purposes for Debit-Orders] This service is on a STRICTLY ADVANCE PAY OPTION (except account). That is payment is due on or before the first Monday of each calendar month. The billing cycle is for a minimum 1-month period starting every at the beginning of each calendar month. A minimum 30-day written notice shall be required before any termination request shall be processed after 1-year of full service.

Checkboxes

I have read and accepted Terms of Services *

Click Connect

Internet Service Application Form

Internet Service Application Forms

+267 311 3002

info@clickconnect.co.bw

+267 73 152 077