forminator – online form

Service Order Form *New RequestUpgrade/DowngradeTerminationRelocate

Date *

Customer Name *

CPR *0 / 9

Email Address *

Phone *

Flat No *

Building *

Road No *

Block No *

For Existing Subscriber

Account No. *

Fixed Public IP *

Circuit No. *

BROADBAND INTERNET PACKAGES *eFiber 100 – Speed 100/20 – Threshold Unlimited – Throttle N/A – Monthly Charge BD 16eFiber 200 – Speed 300/150 – Threshold Unlimited – Throttle N/A – Monthly Charge BD 23eFiber 300 – Speed 300/150 – Threshold 1.5TB – Throttle 50 – Monthly Charge BD 30eFiber 500 – Speed 500/250 – Threshold 1.5TB – Throttle 50 – Monthly Charge BD 40eFiber 1GB – Speed 1024/512 – Threshold 1.5TB – Throttle 50 – Monthly Charge BD 125

Add-onFixed IP Address BD 5 / MontheLine FreePair of Mesh Routers BD 4 / Month

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