Afrisys

 

DigiFAX  On-Line Order

Agent's Code:   (DO NOT CHANGE)
 
STEP 1
Company or Individual Details
Name of company or Close corporation or partnership or individual:
Registration No. or ID No.:
Industry Type:
Co VAT Registration Number:
Physical Address 
Street:
Town / City:
Postal Code:
Postal Address:
City:
Code:
  
Administrator Details
Name:
Job Title:
Work Number: (no spaces or dashes)
Fax Number: (no spaces or dashes)
Cell Number: (no spaces or dashes)
Email Address:
Note: Confirmation will be sent to this email address.
Email Addresses For Your Fax to Email Numbers
Please supply email addresses to be linked to your Fax to Email numbers:
1st Fax to Email number to be linked to email address:
 		 email address
Sending and/or Receiving
  
2nd Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
3rd Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
4th Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
5th Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
6th Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
  
7th Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
  
8th Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
  
9th Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
  
10th Fax to Email number to be linked to email address: email address
Sending and/or Receiving
  
STEP 2
Debit Order Form
Debit Order Information
Payment method
Account Holder
Account Number
Account Type
Bank
Branch Name
Branch Code

 

 

Should you require additional Fax to Email numbers, email details to digifax@afrisys.co.za
Please read Terms & Conditions for the above
services before submitting this Order form
Also available for download here

 
On submitting the above information, I hereby declare that I have read and agree to the Terms & Conditions stipulated on this web page.

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Last Updated: 2010-09-06

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