DATA Account Order Form
Should you be interested in our Cell C LTE Deals, you need to remember it is subject to LTE Coverage in your area. We will not supply you the Plan if there is no coverage.
Title
*
MR
MRS
MS
Full Name
*
First Name
Last Name
ID Number
*
BirthDate
-
Day
-
Month
Year
Home Number
-
Area Code
Phone Number
Cell Number
*
Please enter it as 27721232710
E-mail
*
Confirmation Email
example@example.com
Residential Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Employer
*
Please give full details of your employer
Work Tel Number
*
-
Area Code
Phone Number
Work Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
How long have you been employed at this company
*
Less than 6 months
Between 6 and 12 months
More than 12 months
Product Information
LTE Package
*
None
VOX Telkom Lte 20gig Day / 20gig Night Surfer R260.00 pm
VOX Telkom Lte 40gig Day / 40gig Night Surfer R360.00 pm
VOX Telkom Lte 60gig Day / 60gig Night Surfer R550.00 pm
VOX Telkom Lte 80gig Day / 80gig Night Surfer R620.00 pm
VOX Telkom Lte 120gig Day / 120gig Night Surfer R790.00 pm
VOX Telkom Lte 220gig Day / 220gig Night Surfer R1100.00 pm
MTN LTE 30Gig pm Day + 30Gig Night pm = R299 pm
MTN LTE 60 Gig pm Day + 60Gig Night pm = R450 pm
MTN LTE 100Gig pm Day + 100Gig Night pm = R620 pm
MTN LTE 150 Gig pm Day + 150Gig Night pm = R870pm
Select your Bundle
Device Options
*
YES - I would like to RENT a Router at R100,00 per month (incl VAT). Must be returned, undamaged, when you cancel your contract.
YES - I would like to PURCHASE a Router - R1270,00 including VAT.
NO - I have my own Router
Please submit a Clear Colour Photo of your ID
Browse Files
Regulation of Interception of Communications (RICA) Act 48 of 2008
Cancel
of
Please submit proof of residence not older than 3 months
Browse Files
Regulation of Interception of Communications (RICA) Act 48 of 2008
Cancel
of
How did you hear about us
*
Facebook
Friend
Cashback World
Google Search
By Submitting this Application form you have read and understood the terms and conditions. A copy of the Terms and Conditions will be emailed to you for your records.You also confirm that the information provided in this application is true and correct.
*
YES
Should you decide to take the VOX Telkom LTE you agree that you will accept their Terms and Conditions. A VOX Quote will be sent to you. VOX may charge you an Activation fee of R149.00
*
YES
You agree that you understand that your account will be suspended with immediate affect if you miss any payments and will be liable or any outstanding charges and penalties that may incur due to your missed payment.
*
YES
You accept that if you choose our Telkom LTE, you will be subjected to a 12 calendar month contract.
*
YES
You accept that if you choose to cancel any of the above Packages you will be liable for a Cancellation fee of R1200.00 incl VAT
*
YES
Submit
Should be Empty: