Don’t see the form?

Please scroll down or refresh the page in case the form did not load.

LTE-A ORDER FORM

This page is secure

Dear applicant. The information you are about to supply to bitCONNECT will serve to aid us in processing your application. bitCONNECT will not share, sell or otherwise distribute this information. Our website is encrypted to protect you from prying eyes. Please ensure that you see the green lock icon in your browser address bar before you submit any information.
Referral Code
Application type
Is this application for a person or a business?
Company Name
Company Registration Number
VAT Number
First Name
Last Name
ID Number
Primary Phone Number
Secondary Phone Number
Email Address
Address Line 1
Address Line 2
City
Post Code
GPS Coordinates

Packages

Choose Your Package
  • - select a option -
  • Rain 25GB R299
  • Rain 55GB R549
  • Rain 85GB R799
  • Rain 120GB R999
  • Rain 220GB R1349
  • Rain 330GB R1599
  • Cell C 50GB R349
  • Cell C 100GB R530
  • Cell C 200GB R850

Hardware

LTE Router
Please choose whether you need a SIM only or an LTE router

Totals

Total Monthly Cost
The total amount that will be payable monthly
MonthlyR0.00
Total Once-off Cost
The total amount payable once installation is complete
Once OffR0.00
Payment Terms
You may choose to pay your router over a specified period of time. Please choose below the payment terms you prefer
-
+
Account Name
Account Number
Salary date
On what date is your salary paid into your account?
Bank Name
  • - select a bank -
  • ABSA
  • Capitec
  • FNB
  • Nedbank
  • Standard Bank
Account Type
  • - select account type -
  • Current/Cheque
  • Savings
  • Transmission
  • Credit Card
Branch
Branch Code
DEBIT ORDER AGREEMENT
I hereby request Bronberg Connect to draw against my/our account the total amounts required under this agreement or any renewal thereof and I/we authorize my/our bank to debit my/our account with any amounts drawn against it in terms of this agreement.
I agree to the debit order
Please sign here to agree with the debit order
TERMS & CONDITIONS
Please read and agree to these terms and conditions
I agree to the terms and conditions
Please sign here to agree with the terms and conditions
File 1
Upload your documents... (Max 2MB)
File 2
Upload your documents... (Max 2MB)
File 3
Upload your documents... (Max 2MB)
File 4
Upload your documents... (Max 2MB)
File 5
Upload your documents... (Max 2MB)
File 6
Upload your documents... (Max 2MB)
Upload RICA/FICA Documents
Please ensure that all required documents accompany your application.

Credit Vetting Documentation Requirements

Please review the requirements below and ensure your application is accompanied with all the required documents to avoid unnecessary delays.

Individual / Residential Subscriber

Fully completed Individual Subscriber Agreement
Copy of  SA Bar Coded ID of signatory
Proof of Residence of signatory (not older than 3 months)
Proof of banking account details in the name of signatory 

(Pty) Ltd & Ltd (/07 & /08)

Fully completed Business Subscriber Agreement
Signed Order on Company Letterhead
Copy of  SA Bar Coded ID of authorised signatory
Copy of Company Registration Document(s)
Proof of banking account details in the name of the entity
Resolution (if applicable)

Section 21 Company (Schools, Churches, Trade Unions)

Fully completed Business Subscriber Agreement 
Signed Order on Company Letterhead
Copy of  SA Bar Coded ID of authorised signatory
Proof of banking account details in the name of the entity
Proof of rights to sign for signatory

Partnership

Fully completed Business Subscriber Agreement (Signed by all partners)
Signed Order on Company Letterhead
Copy of  SA Bar Coded ID of all partners
Copy of Partnership Agreement
Proof of banking account details in the name of the entity 

Sole Proprietor

Fully completed Business Subscriber Agreement
Signed Order on Company Letterhead
Copy of  SA Bar Coded ID of signatory 
Proof of banking account details in the name of signatory 
3x Months Most Recent Non-Internet Bank Statements

Incorporated

Fully completed Business Subscriber Agreement (Signed by all members)
Signed Order on Company Letterhead
Copy of  SA Bar Coded ID of authorised signatory 
Copy of Company Registration Document(s)
Proof of banking account details in the name of the entity 

Close Corporation (/23)

Fully completed Business Subscriber Agreement
Signed Order on Company Letterhead
Copy of  SA Bar Coded ID of member signing 
Copy of Full CK Document
Proof of banking account details in the name of the entity 
Personal Surety (if applicable)

Trust

Fully completed Business Subscriber Agreement (All trustees to sign)
Signed Order on Company Letterhead
Copy of  SA Bar Coded ID of all trustees
Copy of Trust Deed Documents  
Proof of banking account details in the name of the trust 
Letter of Authority 

Government / Muncipality

Fully completed Business Subscriber Agreement
Copy of Official Government Order
Copy of  SA Bar Coded ID of signatory 
Proof of banking account details in the name of the entity 
Proof of rights to sign for signatory
Copy of Tender (if applicable) 

Rate
Please Rate & Comment How You Experience The Form Layout
How did you hear about us?
Please let us know where you have come to hear about us.
  • - select a option -
  • Facebook advert
  • Printed advert
  • Word of mouth
  • Google search
  • Other