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Contact Details:
Contact Name
Name of Firm or Partnership
Company Reg. No. or ID
Telephone Number
Fax Number
E-mail Address
Physical Address

Services Required:
Secure E-mail
R49-00
Vax
R90-00
Analogue (56K) Dial-up
R85-00
ISDN (64K) Dial-up
R99-00
ISDN (128K) Dial-up
R199-00
ADSL (512K) Dial-up
3 Gig Limit
R285-00
ADSL (512K) Dial-up
6 Gig Limit
R525-00
ADSL (512K) Dial-up
9 Gig Limit
R795-00

ADSL (128K) Uncapped
R850-00
ADSL (256K) Uncapped
R1 125-00
ADSL (512K) Uncapped
R1 650-00
Mail Hosting
R295-00
Web Hosting
R250-00
Domain Registration (eg. .co.za, .org, .com, .info, .net, .biz, and more)
(R100-00 annual renewal)
R800-00
ISDN Modem (once off)
R928-00
ADSL Modem
(Firewall, Router, 4 Ethernet Ports)
R1 250-00
ADSL Modem
(Firewall, Router, USB and Ethernet Connectivity)
R699-00
Netgear VPN / Firewall, 8 Port Router
R1 600-00

E-mail Addresses
E-mail Address
Alias 1
Alias 2
Alias 3
1. @voffice.co.za
2. @voffice.co.za
3. @voffice.co.za
4. @voffice.co.za
5. @voffice.co.za
6. @voffice.co.za
7. @voffice.co.za
8. @voffice.co.za
9. @voffice.co.za
10. @voffice.co.za

Domain Name:
eg. firmname.co.za .co.za

Support
For support ID purposes please answer the following question:
What is your mother's first name?

Debit Order Details:
Month of first withdrawel: Bank:
Account Name: Branch:
Account Number: Branch Code:

The Subscriber hereby agrees that all services provided pursuant to VOffice's acceptance
of this application form will be subject to the "Terms and Conditions" at
http://www.voffice.co.za/terms.htm and conditions are explicitly incorporated into and form
an integral part of the agreement between VOffice and the subscriber.