HERO WIRELESS
This service order form is for reques
SECTION
A LET’S GET YOU CONNECTED
Property Type Residential: House Residential: Apartment Residential: Townhouse Residential: Estate Residential: Rural
Business: Free Standing Business: Office Block Business: Office Park Business: Rural
SECTION
B INDIVIDUAL OR AUTHORISED RESPRESENTATIVES DETAILS
Full Name and Surname Niva Johnson
6601011010088
Contact Number 0782157729 Residential Address Dwelling
10 MzinziType (Estate,
Avenue,apartment, home, farm)
Body Corporate Approval Yes No Not Applicable Building Name (if applicable)
Kwanonzame,
Landlord/Letting Agent
Body Corporate
Contact NumberApproval Unit Number
Middelburg,
Alternative Contact Person Street Name
South Africa
Alternative Contact Number City
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C BUSINESS DETAILS
This section is for Business Applicants only, Business Applicants must complete section B & C
Company/Org Name Business Address
Dwelling Type (Estate, apartment, home, farm)
SECTIONBusiness Contact Number Building Name (if applicable)
Registration Number Unit Number
VAT Number Street Name
Billing Email Address City
SECTION
D SERVICE ORDER
A separate quote will be required for any connection that requires additional hardware, consumables labour or similar
SELECT YOUR PACKAGE
2Mbps 1Mbps Upload
Ideal for small families R299pm 10Mbps 3Mbps Upload
Ideal for large families R999pm
OTHER
4Mbps
*All packages have no data restrictions
2Mbps Upload
Ideal for small families R499pm Speed Cost
6Mbps 2Mbps Upload
Ideal for medium families R699pm 12 Month subscription + Standard Free-To-Use Router
This is a subsidised Installation fee. If you cancel your service
within 12 months a standard fee of R1500 will be recovered from you.
- R2500 INSTALL
*All pricing is VAT inclusive.
8Mbps 3Mbps Upload
Ideal for medium families R849pm
WHAT YOU NEED TO KNOW Please note that a standard installation comes with 50 metres of cabling.
We provide you with a Free-to-use router. All services are bound by our Master Terms of Service, which can be found on our website
The standard free to use router has wifi capabilities. Any additional Wifi coverage required can be quoted on. www.herotel.com.
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E MANDATORY RICA REGISTRATION DOCUMENTS
The following additional information/ documents are required in accordance with RICA legislation
Individual Applicant Please supply the following documents: Business Applicant Please supply the following documents:
(Drivers Licence not accepted) • Certified copy of your ID document. (Drivers Licence not accepted) • Certified copy of business registration or company letterhead.
• Certified copy of representative’s ID document.
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F DEBIT ORDER MANDATE
This section is for Monthly Recurring Products only.
This section is for Monthly Recurring Products only.
Account Holder Name Niva Johnson
Bank Name Capitec Type of Account Savings
Branch Code Bank Account Number 1679241182
Monthly Debit Order Date 1st 4th 7th 10th 16th 20th 26th
BENEFICIARY DETAILS
Abbreviated Name HEROTEL Bank Name FIRST NATIONAL BANK Branch 250655
A. Authority B. Mandate
This signed Authority and Mandate refers to contract dated 07 / 11 / 202 4 I/We acknowledge that all payment instructions issued by you shall be treated by my/our
(“the Agreement”). above-mentioned Bank as if the instructions have been issued by me/us personally.
I/We hereby authorise you to issue and deliver payment instructions for my monthly commitment due to the C. Cancellation
respect of Internet Connectivity, as well as any other amounts e.g. for extra services to your Banker for
collection against my/our above-mentioned account at my above-mentioned Bank (or any other Bank or I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation
branch to which I/We may transfer my/our account) on condition that the sum of such payment will never will not cancel the Agreement. I/We shall not be entitled to pay any refund amounts which you have
exceed my/our obligations as agreed to in the Agreement and commencing on and continuing until this withdrawn while this Authority was in force, if such amounts were legally owing to you.
Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 20 (twenty)
ordinary working days, and sent by prepaid registered post or delivered to your address as indicated above. If the service is cancelled within 12 months the full amount will be charged for the free installation and
If the payment day falls on a Sunday, or a recognized South African public holiday, the payment day will free to use router, the router is the property of Herotel and needs to be returned. The client will be liable
automatically be the very next ordinary business day. for the cost of repairing or replacing the Router in case of fire, theft, or any form of negligence.
Please note that the amount debited monthly may vary based on the service provided and amount charged D. Assignment
per service item.
I/We acknowledge that this Authority may be ceded or assigned to a third party if the Agreement is also
I/We understand that the withdrawal hereby authorised will be processed through a computerised system ceded or assigned to a third party, but in the absence of such assignment of the Agreement, this Authority
provided by the South African Banks. I also understand that details of each withdrawal will be printed on my and Mandate cannot be assigned to any third party.
Bank statement. Such must contain a number, which must be included in the said payment instruction and
if provided to me should enable me to identify the Agreement. This number must be added to the form in
Section H before the issuing of any payment instruction.
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G DECLARATION
I confirm that I have read and understood the terms of service that can be found at I accept and have read the debit order mandate
https://www.herotel.com/master_service_terms/
I consent to receive promotional information about your products and services.
I Niva Johnson hereby confirm that all above completed information is accurate, I acknowledge that my service is
bound by the Herotel master terms of service. (Customer Signature).
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H CUSTOMER QUESTIONNAIRE
Do you have an existing LAN Network? Yes No If renting or MDU, has owner or Body Corporate consent been obtained? Yes No
How many floors does the building have? 1 How many devices will be connecting to the Wi-Fi?
Where does the Wi-Fi signal need to be the strongest? TBD
Smart TV’s, PC’s or DSTV units that should be connected via LAN? List: TBD
Who referred you to us? Verbal Agreement Ref: 4MKH0R7
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I SALES PERSON/ CONTRACTOR AND AMBASSADOR INFORMATION
For office use only
Sales Person Tracy Hoyer Agent Code
