downloadtheorderform-SWGfL.docVIP

SWGfL FttC and ADSL Service Request Form Important Information To ensure that we are able to complete your order as fast as possible and avoid having to trouble you again for more information, please complete and return this form. The following table will help show the sections that you need to complete: 1.2 1.3 1.3.1 1.4 1.4.1 1.4.2 1.4.3 1.4.5 1.4.7 1.5.1 Mandatory – please complete these sections as fully as you can ( ( ( FttC and ADSL – complete this if you require FttC or ADSL Services ( ( Connectivity Backup – complete this for Backup Service ( ( Optional – complete these only if they relate to your requirements ( ( ( ( ( ( These details are required by the RM IHG engineers for the configuration of the service (router etc). If details are incomplete the setup may be delayed. Once complete, please return this form to SWGfL at sis@.uk, or for assistance drop us a line or call 0845 601 3203 and we’ll be pleased to help. Establishment Details Establishment name Establishment address Establishment postcode Customer ID number (if known) Establishment domain name (website address) Main Contact Contact name Position Contact email address Contact telephone number Alternate Contact Contact name Position Contact email address Contact telephone number FOR INTERNAL USE ONLY Customer ID CPE model Project ID Order number Service Selection Please identify below the service you would like to receive: Service Setup Charge Annual Charge Quantity 1 ADSL Max Option A ￡ 274.50 ￡ 1,574.11 Option B ￡ 599.06 ￡ 1,606.63 2 ADSL2+ Option A ￡ 274.50 ￡ 2,124.11 Option B ￡ 599.06 ￡ 2,156.63 ADSL2+ Annex M Option A ￡ 274.50 ￡ 2,474.11 Option B ￡ 599.06 ￡ 2,506.63 3 FttC Option A ￡ 304.50 ￡ 2,849.31 Option B ￡ 629.06 ￡ 2,881.83 4 Connectivity Backup Service ￡ ￡ Required ADSL Backup Service Option 1 2 3 4 5 6 7 For ADSL Backup Service, please select the Service Option you requir