+27 28 722 2705
onlineshop@riebens.co.za
Heidelberg, Western Cape, 6665, South Africa
Wireless Internet (WiFi) Application Form
Complete this online form and submit it to allow Riebens Computers to determine the best installation package and date/time based on your selections. All personal identification information will be strictly used only for the WiFi contract and not re-used or sold to others.
Contact Details
Register As :
Title
  • Company Name
  • First Name
  • Registration No
  • * Last Name
  • VAT No
  • * Id/Passport No
  • * Email Address
  • Mobile No
  • Telephone Number
  • * Physical Address
  • Postal Address
Installation Details
The Antenna is a 5Ghz antenna and transmit and receive on a licensed band. This means there is less interference than with the unlicensed 2.4Ghz band. The antenna and transmitter/receiver is the property of the account holder (you)
Installation Type:
WiFi Credentials
  • Radio (Display Name)
  • Password
Closest town :
  • Install Address
GPS Coordinates
  • Latitude
  • Longitude
  • Total Installation Cost :
Account Details
Accounts need to be paid in advance. Accounts paid before the 1st of the month, will be active for that month. Unpaid accounts will be suspended and a re connection fee may apply after the payment is received.
Account Type
  • Comments
Debit Order Mandate
  • Bank Name:
  • Bank Account Name:
  • Branch Name:
  • Bank Account No:
  • Branch No:
  • Bank Account Type:
Day of the Month:
  • Debit Order Start Month:
  • ...
This signed Authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). I / We hereby authorise you to issue and deliver payment instructions to the bank for collection against my / our abovementioned account at my / our above mentioned bank (or any other bank or branch to which I / We may transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address indicated above
In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account
Monthly; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less that the obligation due
I / We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you
I / We acknowledge that all payment instructions issued by you shall be treated by my/our above-mentioned bank as if the instructions had been issued by me/us personally
I / We agree that although this Authority and Mandate may be cancelled by me / us, such cancellation will not cancel the Agreement. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
I / We acknowledge that this Authority may be ceded to or assigned to a third party if the agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party
Authorization
This contract may be canceled by me/us by giving you (Riebens Computers) a calendar month in writing sent by  registered post/email, but I/we understand that I/we shall not be entitled to any refund of amounts which have been paid while this contract was in force if these amounts are legally owed to Riebens Computers Pty Ltd.
  • * Name and Surname
  • * Location 
  • Characters