MWEB ADSL Promotion Application Form

MWEB Connect (Pty)Ltd100 Fairway CloseCape Town 7463Reg: 1996/015134/07VAT: 4390165688Customer No:MWEB Authorisation:Product/Promo Code:Office useMWEB ADSL SPECIAL OFFER CONDITIONS3 Months Subscription OR Router Included1. Get the first 3 months of the 12 month subscription free or get the router on offer included if your contract endures forthe initial 12 months.2. This special offer for MWEB ADSL services, excluding the 1GB, 2GB, business and all unshaped packages, is onlyavailable on a 12 month fixed term contract to new MWEB subscribers who take up this offer via a MWEB AccreditedDealer or participating Multichoice Agency.3. This offer is neither transferable nor available in conjunction with any other MWEB promotional offer and all line rentalsare excluded on data only packages..4. Upgrades are not allowed in the first 3 months and downgrades are not allowed for the 12 month fixed term.5. These conditions are in addition to our General Terms and Conditions and the ADSL Service Terms (“the Terms”) and inthe event of any conflict these conditions will override the Terms.6. This offer is valid until 31 December 2011 if all Terms and conditions are accepted.7. You may receive some benefit (e.g. a voucher or discount on hardware or the like) from the sales channel where you arepurchasing this MWEB Service. If so then you must take note that you receive this benefit because of this subscriptionwith MWEB. Where we are allowed in law to charge a reasonable cancellation charge (e.g. upon early cancellation of afixed term agreement) the value of any benefit received, whether from the sales channel or from MWEB, as part of thisoffer (e.g. router included) will be taken into account when we determine the reasonable cancellation charge payable byyou upon cancellation.Please sign your initials hereon every page