Please complete the application form below. Once you have submitted this application it will be sent to our credit department for scoring and you will be notified of the outcome.
Personal Details
Title
Please Select
Mr
Miss
Mrs
Dr
Ms
Prof
Name
Surname
ID number
Work number
Home Number
Cell number
Email address
Current monthly airtime
Please Select
100
150
200
250
300
350
400+
Home Address
Residential Status
Please Select
1. Rent
2. Own
3. Other
Number
Street name
Suburb
Province
Please Select
Gauteng
Eastern Cape
Free State
Kwazulu Natal
Limpopo
Mpumalanga
North West
Western Cape
Northern Cape
Years at address
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Employment Details
Gross monthly salary
Occupation
Company name
Year at employer
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Paydate
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Work Address
Building name
Number
Street name
Suburb
Province
Please Select
Gauteng
Eastern Cape
Free State
Kwazulu Natal
Limpopo
Mpumalanga
North West
Western Cape
Northern Cape
Banking Details
Bank name
Account number
Account type
Branch code
We need an activation password from you. This is purely for security reasons so that when you receive your phone and call in to activate it we know that we are talking to the right person and it is not being activated incorrectly.
Password
OFFICE USE
Agent ID
Package ID
