Please fill in the below required details

Student / Occupant

Gender

Male Female

Name

Surname

E-Mail Address

ID Number

NWU Student Number

Current Year of Study

Student Cell

Bursary

Yes No

Parent / Guardian 1 Details

Name

Work Number

Surname

Cellphone Number

ID Number

Physical Address

E-Mail Address

Parent / Guardian 2 Details

Name

Surname

ID Number

E-Mail Address

Work Number

Cellphone Number

Physical Address

Alternative Contact Details

Name

Contact Number

Surname

Work Number

Payment Details

Banking details:

DYNAMIC LIFESTYLE INVESTMENTS (PTY) LTD
ABSA BANK: 9342070443, ACB KODE: 632005
FOR THE FIRST PAYMENT PLEASE USE PARENT ID NUMBER,
THEREAFTER PLEASE USE THE REFERENCE NUMBER PROVIDED ON YOUR INVOICE

Once-Off Payment

Total: R

Recurring / Monthly Payment

Total: R

Payment Method

Payfast EFT/Online banking

T&C's

I hereby confirm that I have read, understand and furthermore agree to the terms and conditions as set out in the rental agreement

View T & C's Here