Internet Subscription Form

 

      

Configuration Information

Dial-up Numbers - 0413972000 (PE) - Username= username@algoanet.com
0860007249 (National) - Username= username@algoanet.com@is.co.za
IP address & name servers will be auto assigned
Mail server-  POP3 = pop3.algoanet.com
Account name is your full email address
The outgoing mail server = smtp.dial-up.net or smtp.isdsl.net
 

 

28 Boshoff Street
Westering
P.O.Box 34191
Newton Park, 6055
Port Elizabeth.
Tel: 041 360 4918
Fax:: 041 360 4930
After Hours Support:
083 2263022

                                                                    DETAILS                                                                        

Company Name    :               Postal or Physical Address
Surname               :
First Name            :
Phone (B)             : Phone (H) :
Fax No:                 : Cell No     :

Dial-in User Name :@algoanet.com    Password:  ( 6+ characters )
(E-Mail Address)
                                                                   Dial-up Options                                                                   

                                                            Leased Line & ADSL Options                                                 
Leased line  options
Analogue or Diginet Leased Line - Request a Quote             Quoted Amount:
ADSL options
               Other Amount:

                                                             Web & Mail Hosting Options                                                 
Domain Registration @ R150 (once off)    Domain Name:

                                                                Debit Order Payment Details                                              
Bank:    Branch :    Branch Code:          
Account Number:             Name of account Holder:
Preferred payment Date:      Type of Account :

Authorization for Debit order Payment:
I, The undersigned, hereby authorise Algoanet to process debit transactions against my account, with details
as specified above, in respect of advance payments relating to my subscription to the internet.
 

Signature (or name in case of online subscription):      Date:
    Click on Submit or Print out & fax to 041 360 4930