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Virtual Office Application

Please fill in all fields
 

Personal Details

Title:

First Name:

Last Name:

Registered Company Name:

Office Number:

Mobile Number:

   
 

Location

Province:

City:

Country:

Postal Address:

Postal Code:

Physical Address:

Postal Code:

   
 

How Would You Like Us to Handel Your Calls?

Do you have a preferential number:

(Leave it blank if you want us to randomly select a number for you)

011 563 38..

The company name you would Like us to answer your calls with:

What would you like

us to do with your calls:

* Call forwarding will be at Telkom rates

** SMS messages will be at 39c per SMS

The e-mail address you would like us to send messages to:

* The phone number you want us to forward calls to (optional):

The mobile number you want us to SMS messages to (optional):

Any Other Instructions:

   
 

Success Club Login Details

Enter your E-mail Address:

Password:

   
 

Payment Details

If you are selected, how would you prefer to pay?
   
  Credit card Debit Your bank

Package Lite - R570 per month (No Hot desk Hours)

Package 1 - R1140 per month (Incl. 12 Hot Desk Hours)

Package 2 - R2280 per month (Incl. 40 Hot Desk Hours)

Package 3 - R4560 per month (Incl. 160 Hot Desk Hours)

Please Note - You will be Charged a once-of R500 set-up charge in your first month.

When would you like your debit to go off?  

1st of month

10th of month

25th of month
 

Bank Account Name OR Name on Card:

Bank Name (For Debit Order):

Branch Name OR Expiry Date on Card:

Branch Code OR CVC Number on card:

For Credit card Last 3 Digits on back of Card

Account Number OR Credit Card Number:

Account Type OR Credit card Type:

   

TERMS & CONDITIONS

I/We hereby request and authorise you to draw against my/our account with the abovementioned bank (or any other bank or branch to which I/we may transfer my/our account) the sum of (as stipulated above) or any variable amount pertaining to this agreement, on the 25th, 10th or 1st of each month or the closest working day thereafter, this being the amount necessary for the settlement of the monthly fee due for our use of the Entrepreneur.co.za Business Centre Virtual Office.

 

All such withdrawals from my/our account by you shall be treated as though they had been signed by me/us personally.

 

I/We the undersigned, "instruct" and authorise your agent Netcash (Pty) Ltd, to draw against my/our account or Virtual Card Services (VCS) to draw against my credit card. I/We understand that if bank/credit card details have been supplied, the withdrawals authorised here will be processed by BankServ for debit orders and VCS for credit cards. I/We agree to pay any banking charges relating to this debit order instruction.

 

Assignment:

I/We acknowledge that the party hereby authorised to effect the drawing(s) against my/our account may not cede or assign any of its rights and that I/we may not delegate any of my/our obligations in terms of this contract/authority to any third party without prior written consent of the authorised party.

 

 

 

For any queries please contact the office on 011 563 3800

 

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