Connect X Application Form





CUSTOMER DETAILS



If Applicable;



Please provide proof of Billing and Street Address (Upload below)

Compulsory Requirement



Non-Fiji Citizens must produce passport during signup


Please provide ID during signup. (Upload below) Parent or guardian’s signature is required if customer is below 18 years of age.



PLAN DETAILS











INSTALLATION FEES









LOGIN DETAILS


4-16 characters, a-z in lower case letters with first character an alphabet

4-8 characters, a-z or 0-9 in lower case letters



TELEPHONE DETAILS

ADSL service requires a Telephone/Data Line, please select from the options below

Letter of Authorization from Telephone line owner if the telephone is not registered under your name. (Attach below)











USER AGREEMENT


I/We hereby:

(a) Certify that the particulars hereinabove provided are true and correct.
(b) Agree to pay on demand all charges made by Connect in connection with the above service.
(c) Declare that I/We have read, understood and agreed to comply with and be bound by the provision of Connect X Terms and Conditions.




UPLOAD DOCUMENTS



Maximum 2 files, 3 MB per file allowed.