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Interexcel ADSL Internet Access Sign Up Form
All fields marked with * are Complusory
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I, * (the applicant) hereby applies for the following services (the services) provided by Interexcel at the prescribed fee

Monthly ADSL access:
- R17 100.00  
1. DETAILS
Company Name
Registration No
Vat Number
*Title
*Initial
*Surname
*ID No
*Physical Address
*Postal Address
*City
*Postal Code
*Tel no (Work)
*Cell no
*Tel no (Home)
*Fax no
*Email address
   
2. AUTHORISATIONS FOR DEBIT ORDER PAYMENT
I, the undersigned have read and understood the terms and conditions of this application and the information that I have supplied in this subscription form is, to my knowledge, true and correct in every respect. Payment by direct debit
Bank
Branch
Branch code
Account Number
Account Type




Name of account holder
Signature
Agree
I, hereby give authorisation to Interexcel to withdraw from my/our account, detailed above, their ADSL Services subscription in the amount of R on the first of every calendar month. The first of these payment to be deducted from the for a period of 12 (twelve) months and thereafter monthly until I supply one calendar month in advance written notice of termination of this payment agreement to INTEREXCEL.
 Terms and Conditions

1.         Submitting this electronic application will serve as a valid and binding contract between the Applicant named on the electronic form and Interexcel, after completion thereof by the applicant and receipt hereof by Interexcel.

2.         The services will be provided by Interexcel, with effect from the first day of the calendar month during which the first payment by debit order in terms hereof is effected.

3.         Payment for services will be made monthly in advance on the first day of the month, by debit order, for purposes of which the authorisation for payment by debit order hereafter is completed and submitted to Interexcel as part of this application.

4.         Interexcel reserves the right to, without notice, suspend all services if payment in terms of paragraph 4 hereof is not duly effected on due date thereof, and to terminate this agreement forthwith and without notice if such payment is not effected on or before the next payment in terms of this application becomes due and payable, and/or if such payment is not also duly made on due date thereof.

5.         Subject to the provisions hereof, the services will be provided for a 12 (twelve) month period, whereafter this application will automatically be renewed unless terminated by either party in writing by giving 1 (one) calendar month's notice.

6.         Interexcel hereby excludes liability for any reason whatsoever arising from the provision of the services in terms of this application or otherwise any warranties or representations hereto other than specified in Interexcel's Internet Service Agreement.

 
 
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