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Paytel application form
1. Application Form
Contact Name:
First Name Last Name
Tel Cell
Email ID Number
Company Details:
Company Name
VAT Number (if registered)
MAIN OFFICE NUMBER:
This is the landline number to which we should divert the new Paytel
number too. i.e. Your main business line "hunting line", switchboard
or enquiries line. The line which you will answer to earn income. NB!
(no cell phone numbers allowed, strictly only land line numbers)
Special Intructions:
To which bank account should we pay your commission and deduct the setup fee:
Bank Details: Account type: Savings Cheque Transmission Credit Cardgfedc gfedc gfedc gfedc
Bank Branch Name Branch Code
Account holders Name Account number
gfedc
R 360 - R65 Discount = R 295.00 (once-off setup fee)
I here with authorize Paytel do deduct the onceoff activation fee of R 295 off my bank account.
Terms and Conditions
I hereby acknowledge that I have read and understood all of the conduct rules terms of use policies
as outlined in the terms and conditions on the Paytel Website (www.paytel.co.za) and agree and
accept they form part of this agreement.
Signed at Date Applicants Signature:
Please fax this application to 086 696 4362 Referral ID: 46338
