88880000   METER SERVICES AGREEMENT#   Ideal Prepaid  Application  Manual Form
South African Services Provided by Holistic Systems, 16 Desmond Street, Sandgate Office Park, Kramerville, 2090
CONTACT DETAILS
CONTACT NAME
Contact e-Mail
Cell Phone# Phone#
PROPERTY OWNERSHIP
NAME ON TITLE OWNERSHIP TYPE
company ID number    
Trading names
Nature OF Business
Phone Fax
Street  Address City
province/State postal code/ZIP
METER TYPES (Select Options for required Meters)
 ELECTRICITY     WATER     GAS 
INSTALLATION ADDRESS DETAILS (Select location to install Meter)
INSTALLATION ADDRESS    As Above        Other 
Street City
Province postal code/ZIP
Notes
PREPAID SERVICES (All charges are exclusive of Taxes where applicable)
MANAGEMENT PLAN SELECT RATE  Promotional Rate
Custom Rate
ENTER PROMOTIONAL CODE      
Custom Rate Notes  
ACCOUNT DETAILS
Bank Name Account#
Routing# Account Type
AUTHORIZED BY (Person authorized  to sign Service Agreement)

I/We authorize the company to Debit/Credit the above account with respect to any fees due in terms of this agreement. I/We understand and agree to all the terms and conditions prescribed by Holistic Systems ('the company') as presented in the Terms and Conditions document which I/We have read.
Name      TITLE     Date

 
   0