Net Nine Nine – Rocklands SMI Rocklands SDU SMI form Agents to select your company and name here.(Required) Company NameNet99 Agent Name Clients Name(Required) First Last Enter your clients full name here.HiddenGeocoderUse this button when you are at your clients installation addressLocate this addressClients Installation address Confirm your clients address where the clients fibre should be installed.Ensure marker is on your clients Rooftop (installation address)If the marker is not on the clients rooftop please move the marker by clicking / tapping the map on the clients home.HiddenGPS co-ordinatesInsert your GPS co-ordinates from the mapClients Cell Phone Number(Required)Enter your primary contact number here.Clients Alternative Phone numberClients Email Address(Required) Enter Email Confirm Email Please Enter your clients e-mail address here.Select Your Clients Prefered Fibre Line Speed(Required) 20 Mbps – From R379 p/m 50 Mbps – From R499 p/m 100 Mbps – From R699 pm Write additional notes here.Please contact me when my area goes live to assist me with my Fibre installation. My Client grants Net Nine Nine permission to receive updates and notifications regarding their fibre. Grant Consent(Required) My Client agrees to allow me to share his / her information to be shared with Net Nine Nine and its affiliated companies in order to get their internet installed.PhoneThis field is for validation purposes and should be left unchanged.
