Order Now Dispenser

Order Form

Name

Surname

ID Number

Cell Number

Work Number

Home Number

Delivery Address

Postal Code

Preferred day of delivery

Fees

20 Liter Container and water cooler Rental (cooler rental R100 pm)

Method of Payment

I understand that the fee is payable in advance and will be paid before or on the day of each month

Select payment date

Contract start date

Referral code

Any defects on the cooler will be covered by MS Aqua. Malicious damage to the cooler will not be covered by MS Aqua and coolers will be replaced at cost to the customer. Refer a family member or friend and receive one month free. Only one referral per customer. Dispensers and containers remain the property of MS Aqua.

Come Visit Us

MS- Aqua Office

64 Pienaar street
Manor Heights
Despatch
Eastern Cape
Cell: +27 84 617 1047
Monday to Friday:
08:00am to 17:00pm
info@msaqua.co.za

Get in Touch with us Now

Come Visit Us

MS- Aqua Office

64 Pienaar street

Manor Heights

Despatch

Eastern Cape

Cell: +27 84 617 1047

Monday to Friday:

08:00am to 17:00pm

info@msaqua.co.za

Get in Touch with us Now

Become a Member of MS Aqua today and Qualify for Free Delivery

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MS Aqua

Purified Water

MS Aqua

Purified Water

Order Form

Come Visit Us

MS- Aqua Office

64 Pienaar street

Manor Heights

Despatch

Eastern Cape

Cell: +27 84 617 1047

Monday to Friday:

08:00am to 17:00pm

info@msaqua.co.za

Get in Touch with us Now

Come Visit Us

MS- Aqua Office

64 Pienaar street

Manor Heights

Despatch

Eastern Cape

Cell: +27 84 617 1047

Monday to Friday:

08:00am to 17:00pm

info@msaqua.co.za

Get in Touch with us Now

Refer & Earn

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of

MS Aqua