Please use this form when applying for any of APUA Telecoms services or to transfer services from one location to another. Applicant must be the owner of the telephone landline on which internet services will be established or the owner must accompany the applicant and provide the required details as outlined in the application form or must procure evidence of permission form the owner with supporting documentation.

Customer Details

Picture ID Number

provide the telephone number linked to your account

provide the name on the account

Contact Numbers

Service Details

let us know where you heard about our service

Property Location

This section is required to accurately locate your premises

please sketch a map of the area pointing out your property as well as permanent land-marks such as churches, school or shops

If you can't provide a sketch, describe you property's location

I/We the undersigned applying for the above mentioned service offered by APUA have read and understood the terms and conditions of the service and agree to comply. I/We agree to settle the account promptly on a monthly basis and acknowledge that my/our account can be suspended at any time if these bills remain unsettled after 60 days. I/We also understand my/our landline account must remain current to guarantee continuous internet service. I/We authorize you to contact those above on the accompanying Credit Control Check form for references. APUA inet reserves the right to alter the aforementioned terms and conditions instituted to effectively govern the internet network without prior consultation with the customer.
I hereby grant permission to install internal/external telephone and/or internet equipment as needed on the property listed at the above service address, and for continued access for the purposes of ongoing maintenance and modifications to the said connection. I further confirm that I am the property owner and/or the person authorized to approve such work on the property listed in the above-mentioned location.