ISP NASHUA MOBILE APPLICATION FORM CORPORATE by gyvwpsjkko

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                                                                                                                                                             Deal
                                                                                                                                                             Number
                                                                                                                                                                              42 James Crescent Halfway House Midrand
                                                                                                                                                                            PO Box 3843 Halfway House, 1685 South Africa
           CORPORATE                                                                                                                                                                  www.nashuamobile.com
                                                                                                                                                                                      Fax: +27 11 207 9000
     APPLICATION FORM (ISP)                                                                                                                                             Sales: 0861 531 531 • Client Services: 0861 412 412

                                                                                                               COMPANY DETAILS
   Existing Client Account No.:                                                                                                        Existing Client Cell No.:
   Company Name:
   Type of Entity:
   (eg. Close Corporation)

   Reg. No:                                                                                                                                              VAT No:
   Industry Sector:                                                                                                                    No of Years Trading:
   (eg. Medical/Financial)

   Authorised Signatory:
   ID Number:                                                                                                                     Designation:
   Account Contact Name:
   Phone Number:
   Postal Address:                                                                                                                                                        PREFERRED STATEMENT DELIVERY
                                                                                                         Postal Code:                                                        E-mail Billing Option:           R         ,            P/M
   Residential Address:                                                                                                                                                      Residential Billing Option: R              ,            P/M
   (domicilium citandi et executandi)

                                                                                                         Postal Code:                                                        Postal Billing Option:           R         ,            P/M
   E-mail Address:                                                                                                                                                           Postal + E-mail Billing Option: R          ,            P/M
   Partner Benefit Scheme:                                                                                                 Scheme Number:
    New Applications: 3 months bank statement and/or
    cancelled cheque to be attached                                                                                BANK DETAILS
   METHOD OF PAYMENT                                               Debit Order                              Credit Card                                     EFT                       Remain as per existing Contract
   Name of Account Holder:

   Bank Name:                                                                                                                            Branch Name:
   Branch Code:                                                                           Type of Account:                            Cheque                                       Other

   Bank Account No:
   CREDIT CARD TYPE                                                Master Card                                                    VISA                                                              American Express
   Credit Card Number:                                                                                                                                            Credit Card Expiry Date:          Y         Y        M        M
   Please specify the day when you would like your debit order to run (Date to be chosen between the 15th and the 1st of the month):
   Billing date for all packages will be the 1st of every month.


                                                                                                      TECHNICAL CONTACT PERSON
   Name:

   Job Title:
   Physical Installation Address:

                                                                                                                                                                                   Postal Code:
   Current E-mail Address:

   Phone Number:                                                                                                               Cell Number:


                                                                                                         MARKETING INFORMATION
  Would you like to receive Marketing & Product related information regarding Nashua Mobile?:                                                                     Yes    Y                    No     N


                                                                                                          MAILBOX PROVISIONING
 Primary User Name:                                                                                                                               @nashuaisp.co.za / nashuabb.co.za
                                                                            (Username for IBurst, ISP and IMS). The Primary user name will also be the primary e-mail address.
                                           Your e-mail address must be no less than 6 and no more than 20 alphanumeric characters. Please do not use the following characters:        # & // ? + () , : \ “

The subscriber acknowledges and agrees that should the subscriber's requested email address already be in use on Nashua Mobile's system, Nashua Mobile' reserves the right to add a numerical digit to the end of the registered address.
This will be actioned without prior notification to said subscriber.


DECLARATION: The subscriber, by signing this application, warrants that:
• He/she/it is duly authorised to enter into a continuous service agreement with Nashua Mobile • The information provided to Nashua Mobile is true and correct • He/she/it acknowledges entering into a service
agreement with Nashua Mobile on Nashua Mobile's standard terms and conditions and that the subscriber agrees to be bound by the standard terms and conditions • The subscriber will have no claims against Nashua
Mobile arising from the application • The subscriber acknowledges and agrees that Nashua Mobile or its authorised representative may conduct a credit search • Nashua Mobile may deduct the charges incurred in respect
of the continuous services from the subscriber's bank account as set out in this application, or as amended from time to time • The Subscriber warrants that, in the event of him/her being under the age of 18 years of age,
that he/she has been assisted by his/her legal guardian when entering into this contract. • He/she/it acknowledges that all the appropriate terms and conditions have been made available by Nashua Mobile and can be viewed
on the internet at http://mvhome.nashuaisp.co.za

Authorised Signatory/ies                                                                         Print Name
                                                                                                                                                                                                                       Date

                                                                                                                                                                                                           Y Y M M D D
Individual Signatory/ies                                                                          Print Name                                                                                                         R 10/ 07/2009



                                                                                        Nashua Mobile (Pty) Ltd.   Reg No: 1986/004789/07 VAT No: 466 0140 494
                                                                                                                           Page 2 of 2
                                                                                                                                                            Deal
                                                                                                                                                            Number
                                                                                                                                                                           42 James Crescent Halfway House Midrand
                                                                                                                                                                         PO Box 3843 Halfway House, 1685 South Africa
           CORPORATE                                                                                                                                                               www.nashuamobile.com
                                                                                                                                                                                   Fax: +27 11 207 9000
     APPLICATION FORM (ISP)                                                                                                                                          Sales: 0861 531 531 • Client Services: 0861 412 412

  Sales Person:                                                                                                                                              Sales Outlet Number:

  Company Order No:                                                                                                                                          Stock Outlet Number:

 Telkom Service No:                                                                                                                                                                RICA Done:         Yes Yes             No       No

                                                                                                                SERVICE REQUIREMENTS
   No. of Lines: Telkom:                                             ISP:                                           APN:                                    IMS:                                       VoIP:
  Tariff/APN Tariff:                                                                                                                                   Monthly Subscription (Incl VAT): R
  (If premium package selected, please complete Nashua Mobile Internet Services Addendum for Domain Registration)

  User Name:
  Initial Period / Contract Period:                                            1 Month                                                   12 Months                                         24 Months
  New ADSL Line Connection Required:                                                                                                                       Yes                                                    No
  If Yes, Do You Have a Telkom Analogue Line:                                                                                                              Yes                                                    No
  Existing Telkom ADSL Line Transfer:                                                                                                                      Yes                                                    No
  (Only Applicable to Bundle ADSL)
  Existing Telkom No:

  Required Speed:                 Up to 384k                                                                               Up to 512k                                                    Up to 4096k
  Physical Address for ADSL:

                                                                                                                                                                          Postal Code:

                                                                                  ADDITIONAL SERVICES / MAILBOXES (Monthly Charges)
                                                                                 Bolt on Services                                                                        Quantity                         Unit Charge (Incl VAT)

                                                                                                                                                                                                     R                         ,
                                                                                                                                                                                                     R                         ,
                                                                                                                                                                                                     R                         ,

                                                                                                                                                                                                     R                         ,

                                                                                                                                                                                                     R                         ,
                                                                                                                                           SUBTOTAL: ADDITIONAL SERVICES (INCL VAT) R                                          ,
                                                                            Service Requirements                                                                                                     R                       ,
                                                                              Additional Services                                                                                                    R                       ,
                                                                                     Insurance              Yes Yes         No   No                                                                  R                       ,
                                                                                                                                                 TOTAL: MONTHLY CHARGES (INCL VAT)                   R                       ,

                                                                                                    HARDWARE (Equipment) (ONCE-OFF)
                                                      Hardware / Accessories / Software / Sundry Costs                                                                     Quantity                         Charge (Incl VAT)

                                                                                                                                                                                                     R                         ,

                                                                                                                                                                                                     R                         ,
                                                                                                                                                                                                     R                         ,
 Gift Card activation cell No:                                                                                                                           TOTAL: HARDWARE (INCL VAT)                  R                         ,
 Delivery Options:                              Collection                                                            Courier                                                       Sales to Deliver

  Designated Person:                                                                                                                                 Contact Number:
  Delivery Address:
                                                                                                                                                                                   Postal Code:
The subscriber acknowledges and agrees that should the subscriber's requested email address already be in use on Nashua Mobile's system, Nashua Mobile' reserves the right to add a numerical digit to the end of the registered address.
This will be actioned without prior notification to said subscriber.
DECLARATION: The subscriber, by signing this application, warrants that:
• He/she/it is duly authorised to enter into a continuous service agreement with Nashua Mobile • The information provided to Nashua Mobile is true and correct • He/she/it acknowledges entering into a service
agreement with Nashua Mobile on Nashua Mobile's standard terms and conditions and that the subscriber agrees to be bound by the standard terms and conditions • The subscriber will have no claims against Nashua
Mobile arising from the application • The subscriber acknowledges and agrees that Nashua Mobile or its authorised representative may conduct a credit search • Nashua Mobile may deduct the charges incurred in respect
of the continuous services from the subscriber's bank account as set out in this application, or as amended from time to time • The Subscriber warrants that, in the event of him/her being under the age of 18 years of age,
that he/she has been assisted by his/her legal guardian when entering into this contract. • He/she/it acknowledges that all the appropriate terms and conditions have been made available by Nashua Mobile and can be viewed
on the internet at http://mvhome.nashuaisp.co.za



Authorised Signatory/ies                                                                             Print Name

                                                                                                                                                                                                                        Date

                                                                                                                                                                                                           Y Y M M D D
Individual Signatory/ies                                                                             Print Name                                                                                                        R 10/07/2009


                                                                                        Nashua Mobile (Pty) Ltd.      Reg No: 1986/004789/07 VAT No: 466 0140 494
                                                                                       TERMS AND CONDITIONS

1. Thank you for choosing Nashua Mobile (Pty) Limited to provide you with the services (“the          10. All of our Products supplied to you are warranted in accordance with industry norms
Services”) and/or products (“the Products”) for the minimum initial period (“Initial Period”) and     against defective workmanship and components, but the terms of our warranty are subject to
other items you have requested in on the subscriber form to which these terms are attached,           the manufacturer’s and/or supplier’s terms of warranty as to duration, “OTB failures”, returns
for the fees and charges (“Charges”). As the Subscriber, you agree that these standard terms          and handling procedures and any Charges. To the extent such warranty terms do not
and conditions shall apply to the provision of such Products and/or Services.                         accompany the Product packaging then, upon request, we will provide you with specific
                                                                                                      applicable terms. The terms of such warranty will prevail over all other warranties and
2. We will use all endeavours to make the Services available as soon as possible but, where           guarantees.
the Services, or any part thereof, are provided directly or indirectly by a third party network or
service provider, including Telkom, then such Services or your connection/access thereto may          11. If we should loan any Product to you or if we are hiring the Products to you, then you bear
be delayed, interrupted or diminished for reasons beyond our control. You agree that we are           all risk of theft, loss, damage or destruction and, subject to our terms of warranty, you will be
not liable for such delay, interruption or diminution. You agree to comply with all usage             responsible for maintenance and support of such Product, unless you contract with us to
restrictions and limitations applicable to such Services, or portion thereof. In the event of         provide maintenance and support Services, that will be at an additional charge.
ourselves agreeing to assist in facilitating your application for an ADSL line through Telkom, we
                                                                                                      12. You agree that we retain all rights in and to any methodologies and all other know-how that
are not liable for any delays and/or on provision of the line from Telkom in any manner
                                                                                                      we possessed or that are created when providing our Services.
whatsoever.
                                                                                                      13. You agree that, unless your losses arise from our fraudulent conduct, we will not be liable
3. This agreement shall commence on the date on which Nashua Mobile activates the service,
                                                                                                      for any consequential losses of whatsoever nature and however arising. In any event, the
such activation being at our sole discretion, and shall endure for the period as stipulated on
                                                                                                      maximum extent of our liability to you will be equal to the amount you have paid to us for the
the subscriber form (“initial period”) and thereafter indefinitely until terminated by either party
                                                                                                      Services.
by giving the other party one calendar month’s written notice of termination (with the
exception of unlimited ADSL, Diginet and server farming services where a 90 (ninety)_days             14. We may assign our rights and obligations to another service provider if we are satisfied it
notice period applies). Such notice of termination shall be effective from the first day of the       will continue to render the Services to you in a manner that is in keeping with our standards.
next calendar month. For clarity purposes and by way of example, in the event of a subscriber,
after the initial period, giving Nashua Mobile written notice of termination during a particular      15. For certainty, these terms, including those in subscriber form, comprise the whole
month (example 28th May), that notice of termination will take effect on the 1st of the               agreement between us and supersede and prevail over all prior agreements and arrangements
following month (example 1st June) and termination will occur at any time (at Nashua Mobile’s         between us relating to the provision of the Services and/or the Products and no other
sole discretion) on the last day of the latter month (example 30 June).                               provisions shall apply unless specifically agreed to in writing by us.

4. The amount/size of memory allocation of any mailboxes that may form part of the services           16. If our authority to procure the Services for you from third party service providers is
are dependant on the tariff/package selected by the subscriber. You agree that the size               terminated for whatever reason, we may assign this agreement to a third party; alternatively,
aforesaid is an allocation per calendar month (as opposed to the billing cycle indicated on the       to suspend or cancel the provision of the Services or this agreement. You will not be liable for
subscriber form) to the mailbox and that any unused portion of the memory allocation/size is          payments in respect of suspended Services in such circumstances.
forfeited if not used in the same calendar month of allocation. This will also be applicable to       17. We will use all reasonable efforts not to disclose, in any manner whatever, any of your or
any additional memory allocation agreed to by Nashua Mobile, irrespective of when such                your customers’ confidential information that may be disclosed to us during the course of
further memory is allocated. The size allocation is per package and not per mailbox.                  providing the Services. . You may refer any disputes related to the provision of our Services
5. The Charges you agree to pay are those stated on the subscriber form, as may be increased          and/or Products to the regulatory body having jurisdiction. You hereby authorise us to use and
from time to time in our current tariff plan. You agree that there will be no pro-rata charges in     disclose to any police officer any information relating to the Products and/or Services supplied
regards to subscription and hence agrees to being charged for a full month in regard hereto           to you and their use.
irrespective of the date on which the services are activated. You agree to pay to us by debit         18. You agree to comply with any notice, directive or policy that governs and/or restricts the
order within 14 days from the date of our invoice, free of deduction or set-off, the amounts          use of the Services and/or Products that apply to all Subscribers/users of the Services (or
stated in our invoice, calculated in accordance with the Charges for the Services and/or              categories thereof) and/or the Products
Products, including monthly access or subscription Charges, initial and reconnection Charges,
migration and other Charges applicable to the Services and/or Products or any “package” or            19. You hereby agree that this agreement or the Services is not conditional upon the
mix thereof for your use or availability. If the Services and/or our agreement with you for the       continued operation or use of any Products purchased, hired or acquired from us or a third
Services and/or Products is terminated for whatever reason before the end of the Initial Period,      party for use in conjunction with and/or to access the Services.
you agree to pay us the sum of inter alia the monthly subscription or access Charges payable
                                                                                                      20. In the event of any of the services being capped, and the subscriber exceeding the
for the rest of the Initial Period.
                                                                                                      cap/limit whether agreed to be Nashua Mobile pr otherwise, the subscriber shall be liable for
6. In the event of any “bolt on services” (additional services) being requested by you, whether       additional charges for the exceeded portion.
on the subscriber form or at a later stage, the supply of such bolt on services will be subject
                                                                                                      21. You agree to Nashua Mobile’s acceptable use policy that is available at
to these terms and conditions as well as additional terms (if applicable), at an additional charge
                                                                                                      www.nashuaisp.co.za or upon request from you.
to you.
                                                                                                      22. We shall be entitled to determine a credit limit applicable to you from time to time and to
7. Our monthly invoice shall be prima facie proof of the amounts owed by you for the Services
                                                                                                      suspend the Services should you exceed such credit limit. However, despite such credit limit
and/or Products and of the other facts stated therein. You shall be responsible to advise in
                                                                                                      being placed on your account, you will be liable for payment if you exceed this limit, whether
writing of your invoicing address as stated in the subscriber form or in such written notice that
                                                                                                      we have notified you of exceeding same or not.
shall be your chosen domicilium citandi et executandi for all purposes under this agreement.
Our address on the subscriber form shall be our chosen domicilium citandi et executandi for           23. Should you breach any provision hereof, then you will be liable for all legal costs on an
all purposes under this agreement. All Charges include VAT, unless stated to the contrary. The        attorney and own client scale including any collection commission incurred by us. Any
other terms of payment are stated in our current tariff plan which is available on our website:       payments shall be apportioned firstly to costs, then interest and then the capital amount owing.
www.nashuamobile.com or that will be made available to you upon request. You agree that
the service provider’s records constitute ostensible proof of your use of the Services and/or         24. You agree that an electronically scanned and stored version of this document shall
Products.                                                                                             constitute sufficient evidence of its content and signature by you and us.

8. We will provide the Services in a professional and diligent manner and will respond to your        25. If the Subscriber is a corporate entity or trust, then the signatory hereto who signs on
requests for on-site maintenance and support, if applicable to the service you have requested,        behalf of the Subscriber ("the signatory") warrants that he is duly authorised to enter into this
as soon as possible on our usual terms or as agreed in writing. Should you request any                contract on behalf of the Subscriber and to sign the debit authorisation, if applicable, on the
additional or different Services other than those in the subscriber form then such Services will      Subscriber’s bank account. By his signature hereto the signatory hereby binds himself as
be subject to these terms and additional agreed terms and Charges.                                    surety and co-principal debtor on behalf of the Subscriber unto and in favour of us for the due
                                                                                                      and punctual fulfilment of all of the Subscriber’s obligations to us arising out of this agreement
9. Delivery of all Products will be dependent upon stock availability and other factors. Upon         including the payment of all Charges and liquidated damages. The signatory agrees that we
delivery to you, all risk in and to the Products will pass to you. You agree to comply with the       may give time to, and otherwise enter into any arrangement with, the Subscriber without
manufacturer’s instructions and all licensing terms where software is supplied for use with the       prejudice to our rights against the signatory as surety and co-principal debtor.
Products and all other use restrictions. Your sign-off of our delivery advice, timesheets or other
acknowledge means that you are satisfied that we have performed the Services and/or
delivered the Products and that we may charge you accordingly.




 Customer Acknowledgement

								
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