iiNet Sign-up

Basic

1

Customer

2

Contact

3

Address

4

RICA

5

Terms

6

Submit

7
Individual or Business Representative:
Registered Business Name
Trading Name
Registration Number
Vat Number
Customer:
Title
ID /Passport
Name(s)
Surname
Contact:
Home Contact Number
Work Contact Number
Mobile Contact Number
Email Address
Address:
Physical Address

Area

City

Postal
Only select applicable checkboxes and attach applicable documents with application:
ID Copy
Proof of Residence not older then 3 months
Personal details concurwith banking details

Terms:
I accept the package details as well as the terms and conditions of this agreement.
I accept responsibility to inform iiNet Connect should my address change.
I accept responsibility to inform iiNet Connect if my banking details change.