CNS INTERNET SERVICE PROVIDER

P.O. Box 39849 : Queensburgh : 4070 : South Africa
Phone 031-7081480 or 0835349833 : Fax 031-7082046 : Email sales@cnsisp.co.za

APPLICATION FORM

 

 

 

TERMS PRICES SELECT
Internet + E-mail R100.00 Monthly
E-mail dialup R 50.00 no internet access
E-mail only each R40.00 Monthly
ISDN 64k R175.00 Monthly
ADSL Monthly (3 gig) R275.00 Monthly
Other  

Customers Details

Name / Company
ID. No. of signature
Postal
Suburb
Postal code
Physical Address.
Suburb
Tel: (Work)
Fax No.
Tel: (Home)
Cell No:
Dialup and E-mail Information
E-mail {1} Is This Email Yes or Alias Yes
Password Mailbox @cnsisp.co.za
E-mail {2}  Is This Email Yes or Alias Yes
Password Mailbox @cnsisp.co.za
E-mail {3}  Is This Email Yes or Alias Yes
Password Mailbox @cnsisp.co.za
E-mail {4}  Is This Email Yes or Alias Yes
Password Mailbox @cnsisp.co.za
E-mail {5} Is This Email Yes or Alias Yes
Password Mailbox @cnsisp.co.za
Date Required

I acknowledge the above information to be true and accurate and that I will be bound by the terms
and conditions of this contract (terms and conditions on request ).

I ACCEPT ------YES NO

SPECIAL INSTRUCTIONS