Wireless Internet Application Form
  • Customer Details

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  • Last Name*
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  • First Name*
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  • Date*
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  • Company Name*
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  • Billing Address*
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  • Install Address*
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  • Village/Town*
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  • Home Phone*
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  • Work Phone*full name
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  • Fax*
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  • Mobile*
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  • Billing Email*a valid email address
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  • Technical Details

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  • Username*
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  • Password*
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  • Choose your wireless internet plan

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  • *
    MegaMax (1024k/256k) $129.00/mth
    MegaMax Xtra (1024k/512k) $149.00/mth
    MegaMax Plus (1544k/256k) $169.00/mth
    Super MegaMax (2048k/256k) $199.00/mth
    MadMax 2 (2048k/512k) $259.00/mth
    MadMax 3 (3072k/512k) $379.00/mth
    MadMax 4 (4096k/512k) $495.00/mth
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  • Acknowledgement*Please check the checkbox to confirm you order and that you are aware and agree with the listed prices + ABST.
    I Agree
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