Customer Details

    Current Address

    Service Requirements

    Hardware Requirements


    I/We, the undersigned, confirm the accuracy of the information contained in this application and warrant that I/We am/are duly authorised to sign on behalf of the Subscriber. I/We acknowledge that I/We have read, understood and agree to be bound by the Subscriber's Standard Terms and Conditions upon signature hereof. I/We further acknowledge that the aforesaid Terms and Conditions have been made available by Wozacom (Pty) Ltd on the internet at I/We hereby instruct Wozacom (Pty) Ltd to debit my/our bank account each month with the amounts which we are due and payable in terms of this agreement. I/We hereby consent to Wozacom (Pty) Ltd performing credit clearance verification.