Service Order Form - 3CX Per Extension Reseller InformationCompany Name *Company Registration Number *Company Email Address *Phone *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint HelenaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. MartinSt. Pierre & MiquelonSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Virgin IslandsUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweService RequestEnd-User Company Name *Date Required *Monthly Service Required *Monthly Service Required3CX Multi-Tenant Extention Including 100 minutes (12 Month Contract) = R84.003CX Multi-Tenant Extention Including 100 minutes (Month-to-Month) = R110.003CX Multi-Tenant Extention – extention only (12 Month Contract) = R44.003CX Multi-Tenant Extention – extention only (Month-to-Month) = R77.00Monthly Service Qty *Do you require remote 3CX Support for the site(Recommended) = R250-00? *Do you require remote 3CX Support for the site(Recommended) = R250-00?YesNoTotal Monthly Charges Excl VATRAdditional Voice FeesPlease Note:Additional voice usage fees will apply if your total call minutes exceed the allocated minutes included in your extension package. These excess minutes will be charged at a blended rate of R0.39 per minute. Example:If your plan includes 4 extensions, each with 100 minutes:4 extensions × 100 minutes = 400 included minutes If your actual usage for the month is 500 minutes, you will be billed for the extra 100 minutes at R0.39 per minute. You will be billed for an additional 100 minutes at a rate of 0.39c per minutePorting InformationDoes the customer need to port Numbers? *Does the customer need to port Numbers?YesNoPorting Service Required *Porting Service RequiredNumber Portability – Telkom Numbers = R140.00 eachNumber Portability – All Other Numbers = R50.00 eachNumber Portability – Telkom Managed Porting / 100 numbers = R600.00 eachPorting Service Qty *Total Porting Charges Excl VATRUpload Porting Documentation *The following documents needs to be uploaded: Porting Letter of Authority_Client, Geographic Number Porting Request Form, Migration Authorisation. Failing to upload the documents will delay the porting process.Drag and Drop (or) Choose FilesThe Fine PrintOnly Approved Staff Members of the the Reseller are allowed to submit a Service Order FormFirst Name *Last Name *Designation *Email Address *Terms and ConditionsPlease refer to your 3CX Per Extension Reseller Agreement.Consent *Yes, I agree with the privacy policy and terms and conditions.SignatureStart signing your signature hereYour browser does not support e-Signature field. Submit Order
