Customer Type: *

• New Customer
• Existing Customer
  Change Plan
  Additional Plan
  

Customer Name *
Date of Birth *
Occupation & Employer *
T.I.N No: *
Phone Contact *

Service Referred by:

(Optional)

Identification: *

Please provide one (1) of the ID listed below. (Upload in Step 4) Parent or guardian will sign up if customer is below 18 years of age.

Upload Documents

Upload Copies of IDs *

"Maximum 2 files, 10MB per file allowed."

Address Details

Primary Email Address *
Secondary Email Address
Home Address *
Pickup Location - Select Location - Roadshow CE Ganilau House Customer Care, Suva Garden City Customer Care, Raiwai Nausori Customer Care Sigatoka Customer Care Nadi Customer Care Namaka Customer Care Lautoka Customer Care Ba Customer Care Tavua Customer Care Centre Rakiraki Customer Care Labasa Customer Care Savusavu Customer Care Taveuni Customer Care