MTN Data Connect Order form

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*
Full Name*

First NameLast Name
ID Number*
BirthDate

DayMonthYear
Home Number

Area CodePhone Number
Cell Number*
Please enter it as 27721232710
E-mail*

Confirmation Emailexample@example.com
Residential Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Employer*
Please give full details of your employer
Work Tel Number*

Area CodePhone Number
Work Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
How long have you been employed at this company*

Less than 6 monthsBetween 6 and 12 monthsMore than 12 months
Product Information
LTE Package*
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 Cancelof
Please submit proof of residence not older than 3 months

Browse Files
Regulation of Interception of Communications (RICA) Act 48 of 2008 Cancelof
How did you hear about us*
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
Should be Empty:

DATA Account Order Form