Join Us

*Initials:

*Title:

*Surname:

*ID Number:

Current
E-Mail :

Phone Numbers:

*Home:

Home Fax:

*Work:

Work Fax:

Cell no:

*Physical Address

  Complex:

  Number:

*Street:

*Number:

  Suburb:

*City:

*Province:

*Postal Code:

Postal Address:

PO Box:

Suburb:

City:

Province:

Postal Code:

Name of Business:

Registration Number:

Designation:

Dedit Order Payment:

*Name of Bank:

*Account No

*Branch:

*Branch Code:

Type of Account:

Business Name

*Account No

*Name of Bank

*Branch

*Branch Code

Type of Account:

I/We hereby request the following service/s from Atlantic Internet Services.

Service:

Unit Price:

Personal Dialup Connection:

Full internet access, 5 e-mail address,
5 MB free personal Web space
(Your web address will be: http://www.users.lantic.net/name)

R 75 / month   

Blue Stingray Domain

Full internet access, 2 @lantic e-mail addresses,
5 MB Domain (commercial) Web space.
MailScan
(Your web address will be: http://www.yourrname.co.za)

R 99 / month   

64Kb ISDN Dialup Connection:

Full internet access, 2 e-mail addresses,
5 MB free business (commercial) Web space.
(Your web address will be: http://www.isdn.lantic.net/name)

R 119 / month

Additional e-mail addresses:

Additional e-mail addresses for family members,
business colleagues or yourself.
(Your e-mail address will be: name@lantic.net)

R 10 / month   

E-scan Virus software:

For only R25 a month this virus package protects your computer against Viruses that can damage your data and computer hardware.
(12 Month contract only)

R 25 / month   

Email addresses
Please provide us with your choice of Email address, not less than 2 characters and not more than 10 characters(e.g. John Dow - jdow@lantic.net) or (ABC Suppliers - abcsup@lantic.net), be sure to provide 2 options to avoid any delays if not available.

Additional e-mail (if applicable)

Contact person to be notified

I/We hereby request you to draw against my/our account, with whichever bank/building society it may be, the amounts required under the above mentioned Contract or any renewal thereof.
I/we authorise my/our bank/building society to debit my/our account with any amounts drawn against it in terms of this Contract.
I/We hereby understand that the services rendered will be subject to Atlantic's use policy as amended from time to time. A copy of these conditions is available at http://www.lantic.net/usepolicy. Interest is payable on all arrears payments at a rate determined by Atlantic from time to time.
An administration service fee of R10 will be levied on all non-payments via debit order.

I/We acknowledge that termination of this contract is not possible within the first three months and agree to give one calendar month's written notice to terminate this contract. Should I/we fail to pay my/our account I/we shall be liable for any collection, tracing and/or legal fees. I/we hereby confirm that above mentioned physical address shall by my/our domicilium citandi et executandi.

I/We indemnify Atlantic Internet Services against any damage, loss, claims or cost that may result from work being done in connection with the service being rendered, removal of the service and/or my/our computer equipment not being compatible.
I/We acknowledge that I/we will be charged additional fees for work being done by Atlantic on any computer equipment to be able to access the network.