Online Application Form
 
Fax2Mail Solutions
 
Personal Information
Name & Surname: *
Company:
VAT number (if relevant):
Company Contact:
ID / Company Registration Number: *
Email Address: *
Telephone Number: *
Fax Number:
Mobile Number:
Postal Address: *
 
Service Requirements & Cost
Please indicate your choice of email solution by selecting from the list below *
 

Monthly
Fax2Mail Local Fax
(Send & Receive)
(0866 Fax Number)		    R29.95
Fax2Mail International Fax
(Send & Receive)
(0xx Fax Number)		    R64.95

Recipient Email Address *
Please specify the email address (account) from which faxes will be sent and delivered to
(Only 1 address / Fax2Mail account)
Intended Delivery & Recipient Email Address:
    


Important Notice *  All prices indicated are exclusive of VAT

Additional Costs *  All prices indicated are for the Fax2Mail service only and do not include sending costs
 
Payment Options & Direct Deposit Details
Payment Options * Direct Deposit Details
Please choose your preferred payment method
Direct Deposit
Monthly Debit Order
Credit Card
A representative will contact you regarding your account details.
Account Holder: Popular Demand Technologies
Account Number: 6202 164 5934
Bank: First National Bank
Branch: The Fountains
Branch Code: 25-79-55
All Deposit Slips to be faxed to 086 686 2622 or sent via email to accounts@populardemand.co.za.
Please include the Invoice Number as reference on the deposit slip/ electronic transfer. We can not be held responsible if the payment cannot be traced.
 

Your Banking Details
Bank Name:    Branch:
Branch Code:    Account Holder:
Account Number:    Account Type:

Credit Card Payments

You will be provided with an invoice number and a secure link for credit card payments,
 as soon as your application has been processed.
 
Confirmation and Submission of Application

By submitting, I agree to the terms & conditions and confirm that all of the information provided in this form is true and correct.

I agree: