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Customer details

Title *
First Name(s) *
Last Name(s) *
Street Address *
Postal Address (if different)
Email *
Cellphone (optional)

Supporting your community

I / We wish to sponsor the following school, Rotary Club or charitable organisation (optional) :

Services required

Your telephone number(s)
(please include your 2 digit area code) *
Select services required *
Want to add on a monthly fixed price call package? Choose your preferred plans(s) here.
Your price matching or savings guarantee please record the name(s) and charges of any (monthly) fixed price services (including calling and/or internet plans) billed to you by your existing provider here:
If Line rental - Please supply me with the following additional line services (optional) :
Any additional line services required - please request here
If Internet services - please choose a monthly data pack that best suits your needs *
Current line rental provider and account number (e.g. Telecom, 123456789) *
Current toll provider and account no.
(if different from above)
Current internet provider and account no.
(if different from above)

Authorisation details

I am applying for the services requested above and acknowledge that by ticking this box I have read and accept your Terms & Conditions. *
Click here to view our Terms & Conditions
Click here to view a PDF of our Direct Debit Authority
Click here to view a PDF of our Variable Credit Card Authority

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Telephone: 0800 234 500
Fax: 0800 170 500

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