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Gconnect ADSL Order Form & Agreement
Requirements:
Operational BT telephone line
- connected to ADSL enabled BT exchange
- within 5.5Km of enabled exchange
- Line is of sufficient quality
- not using incompatible service
Installation Details:
Billing Details:
(if different)
Customer Name:
Customer Name:
Address:
Address
Town:
Town:
County:
County:
Postcode:
Postcode:
Telephone:
Telephone:
Email:
Email:
Service required
(check one box)
Billing Terms
Gconnect ADSL 500 Single User
Gconnect ADSL 1000 Single User
Gconnect ADSL 500 Business
Gconnect ADSL 1000 Business
Gconnect ADSL 2000 Business
Activation fee
£
+ vat
One month's rental
£
+ vat
Security deposit
£
+ vat
Total
£
+ vat
All payable in advance prior to acceptance of order.
Monthly ongoing costs of £
+ vat
Please supply the BT telephone number to install the ADSL service on:
Frequency:
Payment Method:
Monthly
Quarterly
Annually
Credit Card
Standing Order
Invoice
Hardware Option
:
Micro Filter
Samsung
E310
Modem
BT
Voyager
Modem
Samsung
E300
Router
Samsung
E350
Router
Vigor
2600
Router
Vigor
2600x
Router
None Required
Customer Contact Placing Order:
Do you require:
Name:
Network Address Translation (NATs)
Position:
Yes
No
If No NATs, how many IP Addresses:
1
4
8
Do you require DHCP:
Yes
No
Order Total: £ +vat
And finally..
There are 2 dedicated 13A sockets within 2 metres of the installation point
I have read and agree to the
terms and conditions
and also read and agree to the notes for ADSL users.
