powered by MOBILE CONNECT

 

 

    4U TOPUP APPLICATION

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<div id="tfa_FullName-D" class="oneField">

<label class="preField" for="tfa_FullName">Full Name <span class="reqMark">*</span></label> <input type="text" id="tfa_FullName" name="tfa_FullName" value="" size="40" class="required"> <br>

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<div id="tfa_ContactNumber-D" class="oneField">

<label class="preField" for="tfa_ContactNumber">Contact Number <span class="reqMark">*</span></label> <input type="text" id="tfa_ContactNumber" name="tfa_ContactNumber" value="" size="40" class="required"> <br>

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<div id="tfa_EmailAddress-D" class="oneField">

<label class="preField" for="tfa_EmailAddress">Email Address <span class="reqMark">*</span></label> <input type="text" id="tfa_EmailAddress" name="tfa_EmailAddress" value="" size="40" class="validate-email required"> <br>

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<div id="tfa_Options-D" class="oneField">

<label class="preField">Options <span class="reqMark">*</span></label> <span id="tfa_Options" class="choices required"><span class="oneChoice"><input type="radio" value="tfa_IwantanMTNTopup1" class="" id="tfa_IwantanMTNTopup1" name="tfa_Options"><label for="tfa_IwantanMTNTopup1" class="postField">I want an MTN Topup 100 for R995 once off payment</label></span><span class="oneChoice"><input type="radio" value="tfa_IwantaCellCContr" class="" id="tfa_IwantaCellCContr" name="tfa_Options"><label for="tfa_IwantaCellCContr" class="postField">I want a Cell C ControlChat 100 for R995 once off payment                                            </label></span><span class="oneChoice"><input type="radio" value="tfa_IwantaCellphonea" class="" id="tfa_IwantaCellphonea" name="tfa_Options"><label for="tfa_IwantaCellphonea" class="postField">I want a Cellphone and sim card offer- if selected, please specify</label></span></span> <br>

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<div id="tfa_Howdoyouwishtore-D" class="oneField">

<label class="preField">How do you wish to receive your SIM Card?</label> <span id="tfa_Howdoyouwishtore" class="choices"><span class="oneChoice"><input type="radio" value="tfa_IhaveanexistingM" class="switch-a" id="tfa_IhaveanexistingM" name="tfa_Howdoyouwishtore"><label for="tfa_IhaveanexistingM" class="postField">I have an existing Prepaid SIM card and wish to retain my number</label></span><span class="oneChoice"><input type="radio" value="tfa_IhaveanewMTNStar" class="" id="tfa_IhaveanewMTNStar" name="tfa_Howdoyouwishtore"><label for="tfa_IhaveanewMTNStar" class="postField">I would like a sim card with a new number posted to me</label></span></span> <span class="field-hint-inactive" id="tfa_Howdoyouwishtore-H"><span>This must match the selection of topup chosen- ie Cell C prepaid to Cell C Topup</span></span><br>

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<div id="tfa_Enteryourcurrent-D" class="offstate-a oneField">

<label class="preField" for="tfa_Enteryourcurrent">Enter your current prepaid number</label> <input type="text" id="tfa_Enteryourcurrent" name="tfa_Enteryourcurrent" value="" size="40" class=""> <br>

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<div id="tfa_Enteryourcurrent1-D" class="offstate-b oneField">

<label class="preField" for="tfa_Enteryourcurrent1">Enter your current Vodacom or Cell C number</label> <input type="text" id="tfa_Enteryourcurrent1" name="tfa_Enteryourcurrent1" value="" size="40" class=""> <br>

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<p>Account Name- MOBILE CONNECT</p>

<p>Bank- FIRST NATIONAL BANK</p>

<p>Branch Code- 22 28 26</p>

<p>Account Number- 6224 5355 393</p>

<p>Use your&nbsp;ID number as reference.</p>

<p>Please make your payment into the above banking account and fax your proof of payment to or 086 560 4786 or email proof of payment to <a href="mailto:mobileconnect@telkomsa.net">mobileconnect@telkomsa.net</a>.</p>

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