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iBurst Order Agreement
Please complete and submit this form, and a consultant will contact you shortly

 Subscriber Details
Name / Company *
ID No / Passport No *
Company Reg. No
Contact Person *
VAT No
Physical Address *
Code *
Postal Address *
Code   *
Delivery Address *
Code   *
I have been living at this address for   years
I am 
Tel No
Fax No
Mobile No *
Website
E-Mail *
* please complete

 Package
Option 1         30 day notice account and purchase the iBurst device cash

Monthly Subscription
Desktop Device (USB with Ethernet Port) R2839
USB Modem R1699
Webfone R2839
Option 2         24 month Contract (incl Monthly Subscription and Hardware)
         Please choose - For Personal Use For Business Use

Desktop (USB with Ethernet Port)
OR
USB Modem
OR
Webfone

Activation Fee R99

Pay Per Usage Yes No
All new iBurst Wireless, ADSL and HSDPA Packages are Pay-per-use by default. This means that when you have used up your allocated data bundle for the month, you will pay for any extra data you use at an out-of-bundle rate called Pay-per-use. Pay-per-use is charged per mb and rounded up to the nearest mb.You can also save money by buying bulk bundles of Pay-per-use data called Bandwidth boosters. On all iBurst Wireless packages the PPU cost is 95c per mb.

 Extras
Network Coverage
(view map)
Suburb
* your coverage area where you will be using iBurst
Yes, I have checked the map and I have a good signal
Yes, I have checked the map but I would like to verify with a consultant
I have minimal signal and might need an external antenna
Hardware I would like a wireless broadband router - R595
Omni Antenna for my Desktop Modem - R399
Extra Notes

 Other
Where did you hear about us?

 Bank Account Details
Bank Name
Account Name
* e.g. Koos vd Merwe
Branch Name
Account No
Branch Code
Account Type
Please send me RSAWEB updates & news:

 Confirmation

I/We, the undersigned, confirm the accuracy of the information contained in this document and warrant that I am duly authorised to sign on behalf of the subscriber. I acknowledge that I have read, understand and agree to be bound by the terms and conditions annexed hereto. I hereby authorize RSAWEB/iBurst to debit my bank account / credit card with the amounts which are due and payable in terms of this Agreement. I hereby consent to RSAWEB/iBurst performing a credit check on me/us if 24 month contract is selected.