Wireless Broadband Application APPLICATION FORM Your Name*Company NamePhone*Email* Physical Site Address*Capped/Uncapped*CappedUnCappedSpeed*1Mb/s Line2Mb/s Line4Mb/s LineSite Equipment*Rent-To-Own @ R183.36/mo ex.VAT. (12xmonths)Outright Purchase @ R2500 ex.VAT (once-off)