Application for Fibre Application for Fibre Personal DetailsNameID NumberPhoneEmail AddressStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweBusiness Details (If applying for company)Business NameRegistration NumberVAT NumberPhoneWebsitePostal AddressBanking DetailsAccount HolderAccount NumberSelectAccount TypeCurrentSavingsChequeTransmissionBranchBranch CodeProduct SelectionFibre Internet (Choose One)SelectFibre Internet10/10Mbps @ R699 (Uncapped) Frogfoot20/20Mbps @ R799 (Uncapped) Frogfoot50/50Mbps @ R899 (Uncapped) Frogfoot100/100Mbps @ R1 099 (Uncapped) Frogfoot10/10Mbps @ R699 (Uncapped) DNATel25/25Mbps @ R849 (Uncapped) DNATel40/40Mbps @ R1029 (Uncapped) DNATel50/50Mbps @ R1289 (Uncapped) DNATel100/100Mbps @ R1699 (Uncapped) DNATel10/10Mbps @ R699 (Uncapped) ClearAccess20/20Mbps @ R779 (Uncapped) ClearAccess50/50Mbps @ R889 (Uncapped) ClearAccess100/100Mbps @ R1129 (Uncapped) ClearAccess10/10Mbps @ R699 (Uncapped) Vodacom20/20Mbps @ R799 (Uncapped) Vodacom40/40Mbps @ R999 (Uncapped) Vodacom100/100Mbps @ R1499 (Uncapped) VodacomInstallation(Includes Wi-Fi router)12 month contract - FREEIf you cancel your Month to Month Fibre product within 12 months you will be charged the value of router and the value of installation at the time of cancellation.DeclarationDeclaration *Do you accept?I, the undersigned, hereby authorize Netbits (Pty) Ltd to withdraw from my bank account on a regular basis, the amount/s as detailed on my product sign up forms. I have read and understood the Terms and Conditions as specified on www.netbits.co.za. I am aware that monthly charges are 1 month in advance from the date of confirmation. I hereby agree that Netbits (Pty) Ltd shall be entitled to do a credit check on me through ITC or any other recognized institution in order to verify my credit worthiness for contracts. I am aware of the Thirty (30) days calendar notice on cancellation. Except when a 3 to 6 month term is selected above where I will pay the full term.Terms and Conditions *Do you accept?Please see button below to read terms and conditions. SUBMIT APPLICATION TERMS & CONDITIONS Our Office Mpumalanga South Africa Contact Us info@netbits.co.za +27 83 393 0219 Whatsapp 083 393 0219